Interventions to prevent or reduce jet lag

Behavioural and pharmacological interventions may prevent or reduce jet lag. These interventions aim to:

reset the circadian rhythm to the time zone at the final destination
reduce fatigue and improve sleep during travel and on arrival
increase daytime alertness during travel and on arrival.

The behavioural interventions recommended for jet lag are applicable to travellers of all ages, but pharmacological interventions are only suitable for adults.

The evidence for interventions to prevent or reduce jet lag is limited. Despite this, the behavioural interventions in Practices to prevent or reduce jet lag are recommended because they may be effective and are unlikely to cause harm.

Practices to prevent or reduce jet lag can be printed as a handout.

Table 1. Practices to prevent or reduce jet lag
[NB1]
	Adjustments
Before travel	starting 3 days before departure, shift both sleep and wake time by 30 minutes per day so that the sleep cycle more closely resembles the time zone at the final destination Eastward travel: go to sleep earlier and avoid light in the evening wake earlier and seek bright light in the morning Westward travel: go to sleep later and seek bright light in the evening wake later and avoid light in the morning
Inflight	set watch to destination time at the start of the flight keep as physically active as possible during the daytime hours at the final destination maintain adequate hydration by drinking water; avoid alcohol, tea and coffee only sleep during night-time at the final destination; minimise disruptions by wearing ear plugs, an eye mask and layers of clothing to allow adjustment to temperature variation
On arrival at final destination	maximise exposure to sunlight during the day and establish a new routine of meals and activities (including exercise) adults: consider drinking 1 to 3 caffeinated beverages in the morning to improve daytime alertness; avoid caffeine after midday at the new time zone because it can delay night-time sleep delay sleep until night-time at the new time zone; if sleep deprived, take a short nap (up to 30 minutes) upon arrival at accommodation remain in the dark during night-time in the new time zone, even if unable to sleep
Note: NB1: If the stay at the destination is brief (eg less than 3 days), consider keeping home-based hours instead of adopting destination sleep hours because the body clock may not have adequate time to adjust.

In adults, immediate-release melatonin has evidence of benefit to prevent or reduce jet lag. Melatonin plays a central role in regulating circadian rhythms and can prevent or reduce jet lag in adults flying across 5 or more time zones, but may be useful if crossing more than 2 time zones. To prevent or reduce jet lag in an adult, consider:

melatonin immediate-release 0.5 to 5 mg orally, taken on the plane at the bedtime of the final destination; continue for up to 3 subsequent nights¹. jet lag melatonin melatonin melatonin

Avoid internet-sourced melatonin formulations because the melatonin content in these preparations is unreliable.

Avoid combining melatonin with other sedating drugs (eg hypnotics) to aid sleep; the benefits of this practice are unclear and it may cause further sedation.

Limited evidence suggests that hypnotics may reduce jet lag–related insomnia in adults; however, unlike melatonin, hypnotics do not help circadian phase shift. The modest potential benefits of hypnotics may be outweighed by their significant adverse effects including amnesia, confusion, dangerous sleep-related behaviours and risk of dependence. Hypnotic induced-immobility on the plane may increase the risk of venous thromboembolism (VTE) (ie deep vein thrombosis [DVT] or pulmonary embolism [PE])—see below for further advice. If an adult wishes to take a hypnotic for acute insomnia associated with jet lag, assess the risk of misuse and discuss the limitations and harms of the hypnotic with them. Also advise the adult to avoid alcohol and other sedating drugs because combining a hypnotic with other sedatives increases the risk of central nervous system adverse effects.

If after discussing the potential benefits, harms and limitations of using a hypnotic for insomnia associated with jet lag, an adult wishes to take a hypnotic, consider zolpidem, zopiclone or temazepam. The regimens below are ranked in order of the quality and quantity of data to support their use in jet lag and their elimination half-lives—because of the limited opportunity to sleep on a flight, hypnotics with a quick onset of action and short half-life are preferred. Temazepam has the longest half-life and poorer quality data to support its use in jet lag. A suitable regimen is:

1 zolpidem immediate-release 5 to 10 mg orally, taken on the plane at the bedtime of the final destination; do not continue for more than 3 subsequent nights². Start at the lower end of the dose range for older or frail adults³ jet lag zolpidem zolpidem zolpidem

OR

1 zopiclone 3.75 to 7.5 mg orally, taken on the plane at the bedtime of the final destination; do not continue for more than 3 subsequent nights⁴. Start at the lower end of the dose range for older or frail adults jet lag zopiclone zopiclone zopiclone

OR

2 temazepam 10 to 20 mg orally, taken on the plane at the bedtime of the final destination; do not continue for more than 3 subsequent nights⁴. Start at the lower end of the dose range for older or frail adults. jet lag temazepam temazepam temazepam

Immobility associated with hypnotics (or potentially, melatonin at high doses) may increase the risk of VTE. If a person at high risk of VTE wishes to take a hypnotic, they should not start it on the flight and instead start it on the first night at the final destination. For advice on VTE prophylaxis for long-distance travel (ie travel longer than 4 hours), see here.

For considerations in psychotropic use (including principles of use and advice on individual drugs) in females:

of childbearing potential, see here
who are pregnant, see here
who are breastfeeding, see here.

¹ A low melatonin dose (eg 0.5 mg) closely resembles physiological release. High doses (eg 5 mg and higher) can have hypnotic properties.Return

² If the person has not previously taken the hypnotic, advise them to take a dose at home before use on the plane to test for adverse effects.Return

³ The United States Food and Drugs Administration (FDA) recommends using the dose at the lower end of the range for females because of increased risk of an elevated morning zolpidem concentration, which may impair driving.Return

⁴ If the person has not previously taken the hypnotic, advise them to take a dose at home before use on the plane to test for adverse effects.Return