What are Some Ways to Help Jet Lag and Social Jet Lag?

Patient Presentation
A 20-year-old male was going on a 10 day trip to Europe as part of a study abroad experience. His main concern was jet lag and how he could mitigate its problems. His pediatrician and he discussed his normal sleep pattern which was erratic with onset and duration. Most nights he would go to sleep between 1-3 AM and sleep only for 6 hours. He said that this was because of school work and social activities which were in person or online. He denied having any problems initiating sleep once he decided it was time to go to sleep.

The pertinent physical exam showed normal vital signs and his weight and length were 50% and 25% respectively. His examination was normal.

The diagnosis of a healthy male with social jet lag with was made. The pediatrician discussed appropriate sleep hygiene including having a more consistent and normal sleep time. She noted that it is hard in a college dorm situation to not use the bed for studying and social activities but recommended he try to do this. She also recommended that he move the phone out of his reach when sleeping and potentially even use a regular alarm clock that he could quickly turn off to wake himself up instead of using his phone alarm. For the trip to Europe she recommended that he actually move his bedtime back into the evening hours and wake up a bit earlier in the morning for a few days before the trip to shift his sleeping. “I recommend that you eat a real meal in the airport and then once you get on the plane put on some eye shades, ear plugs and use a neck pillow right away to try to get to sleep. That way you have eaten and don’t have to wait for the food service onboard, plus you hopefully will be somewhat tired and can get some sleep on the plane. You should also have a water bottle with you because you likely will need to drink and that way you don’t have to get up and ask for water. I also recommend that once you are awake for the first day, that you do something active to stay awake, so you are very tired the first night in Europe and you can sleep well, ” she recommended. “Okay – eat in the airport, go to sleep right away and once I’m up, I’m up for the day. That should be easier as we are supposed to take a city tour when we land,” he repeated. “I’ll try the other stuff too, but it’s hard to not be online when my friends are there too,” he said. “One thing maybe you all could do, is to turn the phones off together for most nights. That way everyone can get some sleep,” she suggested. He looked skeptical but nodded in agreement.

Discussion
Jet lag is a chronic sleep deprivation that is associated usually with travel across time zones. This is due to the usual timing of the circadian rhythms being upset due to external expectations of normal activities in the new locations. The greater the time zone change and overall deprivation, often the more difficult it is to make the change. Some use a general rule that it takes 1 day for each 1 hour of time zone change to make up for the jet lag. Some people are more sensitive with the direction of the change. Traveling eastward is often associated with the potential opportunity to get some sleep going to sleep earlier but needing to awaken earlier with a shortened total sleep time. Traveling westward often extends the daytime hours during travel because of the need to awaken early to leave on the trip. It does have the opportunity potentially to nap, but there is still a need to stay awake longer until nighttime in the westward destination arrives. Too much napping can also make it more difficult to make the change.

Social jet lag is a delayed sleep phase disorder that “results from a mismatch between social, educational, and biological sleep-wake timing.” These are patients who can’t sleep because they have learned to have a “high alertness levels at sleep time and sleepiness during daylight house, particularly the mornings.” This results in chronic sleep deprivation and many studies support decreased classroom learning and effectiviness. These patients develop long sleep latencies for the bedtime that is appropriate for them, thus shifting their sleeping time to later, and with this shift having a more normal sleep latency with the later bedtime. For example, it takes 1 hour to fall asleep at midnight but only 10 minutes at 2 AM. Patients again have chronic sleep deprivation because they need to get up in the morning for school, work, etc.

Some patients will also have a conditioned insomnia. Beds used to be for sleeping, but for many teens and young adults they are also used for work, and social activities. Thus the bed is not a relaxing place to rest and sleep, but is a place to remain brain active and thus awake.

Chronic sleep deprivation is highly likely if the patient has “frequent, big, weekend sleep-ins” of more than 2 hours from usual awakening time, and/or has a “great trouble waking up, getting out of bed and getting moving on school mornings.” There is a limited amount of time to do any daily activities in the morning with causes the functional problem of being late or missing school. It can be hard to know if a teen has chronic sleep deprivation or is just moody or poorly engaged and grumpy. If these are excessive or causing functional problems, likely chronic sleep deprivation is at least part of the problem.

Learning Point
Recommendations for travel jet lag in additional to 1 day of adjustment per time zone change include:

• Limiting caffeine while traveling
• Eating healthy meals on the new destination schedule as much as possible for a few days before or day of travel
• Use layered clothing to keep oneself at a comfortable body temperature
• Cutting out the light and noise by using eye shades and ear plugs/headphones. Light is a stimulator of increased wakefulness.
• Planning morning arrivals if possible (see eastward travel above)
• Use of melatonin may or may not help some people

Recommendations for help with social jet lag include: