Get Some Sleep: Jet lag? Reset your inner clock
December 7th, 2010
10:25 AM ET

Get Some Sleep: Jet lag? Reset your inner clock

About a year ago, news reports noted that President Obama's medical records said he used medication to help him deal with jet lag, but not which ones he used. I was asked by The Daily Beast to speculate on what drug or drugs he might be taking. “Well,” I said, “obviously he might be using a sleeping pill to help him get to sleep, but also he could be taking a wake-promoting agent such as modafinil (Provigil) or armodafinil (Nuvigil) in order to function better.

“Does it concern you that the leader of the free world could be using medications such as these?” the reporter asked. I was stunned for a moment. Her tone gave the whole topic such gravity. But then I answered: “No."

I would answer the same today, but most sleep doctors do think that there are better ways than drugs to deal with jet lag symptoms. It's important, because anyone who travels extensively can suffer sleep disruption and the resulting affected judgment - whether it's a businessperson, a member of the military or even the president of the United. States.

Although they're usually temporary, there is a growing body of research that shows that frequent jet travel over many time zones may have long-term health risks. Studies have shown increased risk of neurological problems  and cancer. There is even concern that chronically eating at times that are out of rhythm with your circadian clock may put people at increased risk of cardiovascular disease and type 2 diabetes because you are eating at times when your hormones such as insulin are not programmed to respond as well.

We don’t have good data on how many people really have significant problems with jet lag. In 2007, 31 million U.S. residents flew overseas, not including military or government flights. Many of us have a few jet lag symptoms when we travel, but to consider jet lag a true disorder, the mismatch between your internal circadian clock and the new sleep/wake schedule in the new time zone must cause trouble sleeping or trouble staying awake in the daytime.

The severity of the symptoms usually depends on the number of time zones you've traveled across, the length of stay and the direction of travel. Symptoms tend to be worse the more time zones you travel through and the shorter the trip is. Eastward travel is more difficult than westward travel because it is a lot easier to force yourself to stay up later than it is to make yourself go to sleep earlier.

The most important thing you can do to minimize symptoms if you are traveling eastward over more than six time zones is to be very careful in the first few days about when (and how long) you are exposed to bright lights, especially sunlight. Remember, light stimulates chemicals in our brains that promote wakefulness.

If you get off a plane in Paris at 8 a.m., your internal circadian clock is still at 1 a.m. Chicago time. If you immediately go out into the bright morning for a two-hour stroll around the Latin Quarter, then you are getting light exposure in the middle of your biologic night. If the light exposure falls before your Tmin (the minimum core body temperature which typically occurs about three hours before your normal wake-up time), then you will experience a "phase delay" in your sleep time and you are trying to "phase advance."  More specficially, when you try to go to sleep that first night at 11 p.m. Paris time, your biologic clock thinks it is 4 p.m. You are trying advance your sleep time, that is, go to bed earlier than you internal clock wants you to. And if you got light at the wrong time, this will make it very hard for you to go to sleep on Paris time.

The best advice for eastward travel is to avoid bright light, especially sunlight, for the first few mornings. Wear dark sunglasses and a hat or stay indoors if possible. Then get as much sunlight as possible between noon and 4 p.m. In addition, melatonin can be used to help adjust your body to an earlier bed time. It is not being used as a sleeping pill and so it should be taken around 4 p.m. or seven hours before the new bedtime. We usually recommend 3-10 mg.

We recommend avoiding caffeine, alcohol and sleeping pills. These substances can mask jet lag symptoms but do nothing to help realign the internal clock. Most people will adjust to new time zones eventually on their own, but it is estimated that it takes one day per time zone crossed for circadian rhythm to adjust to local time.

For frequent travelers who must be at the top of their game when they are away, they need strategies such as the ones discussed here in order to improve their daytime function. If we can help it, we don’t want the leader of the free world making important decisions in the middle of his biologic night.

Lisa Shives, M.D., is the founder of Northshore Sleep Medicine in Evanston, Illinois. She’ll blog on Tuesdays on The Chart. Read more from her at Dr. Lisa Shives’ Sleep Better Blog.

The information contained on this page does not and is not intended to convey medical advice. CNN is not responsible for any actions or inaction on your part based on the information that is presented here. Please consult a physician or medical professional for personal medical advice or treatment.

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Filed under: Sleep

soundoff (14 Responses)
  1. Justin

    That was a lot to read

    December 7, 2010 at 16:00 | Report abuse | Reply
  2. razzlea

    Check out my health and fitness blog http://razzlea.blogspot.com/

    December 7, 2010 at 16:01 | Report abuse | Reply
  3. GrammarGnatsie

    Try going between HST and EST about three times a year. Not fun.

    December 7, 2010 at 17:40 | Report abuse | Reply
  4. daytripper

    Dr. Shives has a way of writing that keeps me interested even though i do not have a sleeping disorder. Extremely thorough and informative. I keep finding myself making my way back here every Monday!
    Thank you!

    December 7, 2010 at 17:42 | Report abuse | Reply
  5. Ann W.

    Dr. Shives thank you for information I can use. I am plan to go on a world cruise for a year. Now I can better ask informed questions of the travel agency about days at sea and days spent in ports. I am fortunate to be able to sleep on a bed of nails if I need to. As a matter of fact I love to sleep, travel all the time and never have a problem sleeping.

    December 7, 2010 at 22:49 | Report abuse | Reply
  6. Dave M

    I work for a major freight railroad and we have to deal with a constant state of jet lag becuase of our "on call" work schedule. While we dont work in vastly different timezones in is very common to work at 2 am one day 4pm the next day 5am the following day, etc etc. We are forced to sleep, eat etc out of our normal body cycles for 30 years. We must be on the top of our game to keep the public safe and the general pubic should be very worried about the effects of having people running millions of pounds of some of the most hazardous materials in the world through the middle of their towns by sleepy engineers. In the railroad industry sleep and the effects of the lack of sleep is a issue the company is not willing to address or deal with. Thanks for the tips, I will use them to try and keep your safe!

    December 8, 2010 at 06:29 | Report abuse | Reply
    • Cliff

      I can't figure out how pilots crossing many time zones going to the east manage since they have to return to the west within a relatively short time!

      December 8, 2010 at 08:04 | Report abuse |
  7. As-if...

    "the leader of the free world"???
    1. This world is not free at all and
    2. The president of the USA is NOT the leader of any world, probably not even of the USA..

    Such arrogance... Do your research!

    December 8, 2010 at 15:05 | Report abuse | Reply
    • Lisa Shives MD

      I was quoting the journalist.

      December 9, 2010 at 16:06 | Report abuse |
  8. Julie

    Has Dr. Shives ever even traveled frequently between east and west? The biggest problem most people have with jet lag is they are dehydrated from the travel. Drink more water. Additionally, the President of the United States has his own plane. I'm sure he has a bed in Air Force One.

    December 9, 2010 at 20:43 | Report abuse | Reply
  9. Kate

    This post brings back memories. Before children, I made numerous flights from Detroit to Las Vegas and to various cities in California to manage tradeshows. I would wake up at 4/4:30 am (I am not an early bird) so that I could manage EST action items in additon to my tradeshow responsibilities. Follow my blog on fitness and health-related topics at http://katesworkout.blogspot.com.

    December 9, 2010 at 20:46 | Report abuse | Reply
  10. Ron

    After years of travelling to Europe from The East Coast and crossing 6 time zones. I began to realize that it sometimes took nearly a year for my sleep patterns to return to normal. I think Jet Lag is extremely dangerous. I remember spending 2 weeks in Europe and never really getting in sync with the time zone changes. Especially when I would keep in touch with freinds family and business associates back in the states. I found myself living in 2 separate time zones simultaneously. A very unhealthy and unatural way to live. I limit my long distance travel these days. Jet lag is a real drag on my body and mind. In the end none of tricks really work. Unless you move over there and after many months your body chemistry catches up.

    January 2, 2011 at 22:46 | Report abuse | Reply
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    May 16, 2011 at 01:06 | Report abuse | Reply
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