Who Gets Hit

These are just samples of the homespun remedies frequent flyers concoct to cope with the mental mush called jet lag. Of the 8 million or so American business travelers who make overseas trips annually—the stat comes from the U.S. Office of Travel & Tourism Industries—most are flying east-west routes to Europe and the Pacific Rim and have to deal with the irksome fog that throws their natural body rhythm off balance. 

Flying Fatigue

Today, with business so globalized, the problem is - well, global and more aggravating than ever, with hops between San Francisco and Hong Kong (awful), on to Beijing (not bad with one-hour time difference), but then to Dubai (ugh, set your watch back five hours), on to Moscow (OK), but then to Frankfurt, London and back to the United States (big ugh).

Acknowledging how jet lag can temporarily distress   employees heading for a meeting where they’re supposed to shine, companies are turning to consultants for help.

One is Alertness Solutions, a Silicon Valley firm that has worked with JetBlue, Qantas, Singapore Airlines and companies in other industries. Another is Circadian Technologies, headquartered in Stoneham, Massachusetts, with multinational clients such as Exxon, British Petroleum, General Electric, Pfizer, Genetech and Federal Express.

Neither consulting firm claims that it has a guaranteed quick fix for jet lag, but wisely positions the problem in the larger context of flying fatigue, sleep disorders and sensible caretaking of your work schedule.

The Elusive Magic Pill

There’s significant research now going on to help travelers whacked by time-zone changes. It turns out—for example—that light or darkness greatly affects your body clock, otherwise known as your metabolic clock or circadian rhythms (calibrated for 24-hour cycles). It was a major breakthrough in jet-lag research when identified a decade ago at Cornell University.

Yet a simple foolproof solution to the jet lag problem—like a pill you pop—still eludes the medical detectives.

“No doubt, there’s a quest for the magic pill to treat jet lag,” Dr. Abinash Virk, director of the Mayo Clinic’s Travel and Tropical Medicine Clinic, says.

Some 800 to a thousand business travelers undergo brief pre-trip checkups at her clinic annually—with the number of patients increasing about 20 percent each year. Are they concerned about jet lag? “Yes,” she explains, “but they usually say, ‘I deal with it,’ and go on to what they consider more important medical matters.”  These days those concerns might include questions about the SARS and avian flu epidemics along the Pacific Rim.

To add to the complexities of jet lag, travelers don’t all come out of the same box and, in fact, have differing backgrounds and temperaments that can lead to varying reactions when their body clocks are out of kilter.

Guidelines for Long Hauls

There’s no variation in one important aspect of jet lag: Lucky is the traveler with a lot of north-south business in Latin America with few, if any, time zones different from those in the United States. You’re in jet lag-less territory.

It’s the east-west traffic that can make your head soggy—often just before a meeting where you’re supposed to sparkle with crisp comments and ideas.

Out of years of studying the way the body clock works, researchers offer some guidelines to keep in mind when preparing for long flights:

• Going east is worse than going west.
• It takes one day for each time zone away from home up to six or seven days to get fully in sync with local time.
• Travelers who have had to deal with sleep deprivation—for example, on night shifts—can tolerate jet lag better than most.
• And the older you are, the lousier you’re likely to feel when you race through time zones.

When asked how he felt after his quick visit to Baghdad this past summer, President Bush said, “I’m doing all right,” adding, “A little jet-lagged.” Only a little?

That’s because short trips where you barely have time to get unhinged are easier to handle than long global hauls, according to Professor Eastman, who notes that the 60-year-old President was making a fast roundtrip to Iraq. If Bush felt a little out of sync when it was all over, she speculates, it was probably as much because of stress, dining at odd times, and other variations on a normal lifestyle pattern.

Adjusting the Body Clock

Serendipitously the traffic to faraway places like Bangalore, India’s computer center, and Almaty, Kazakhstan, a resource-rich former part of the Soviet Union, comes at a time when the medical establishment is putting sleep disorders—count jet lag among them—under the microscope.

Absent magic pills, researchers have sorted out which drugs work best and what pre-flight procedures do the job better than others. In short, the remedies are now less hit-or-miss and better targeted at the jet-lag problem.

A decade ago melatonin made headlines and drew applause from jet lag sufferers. The “wonder drug” is a hormonal substance made by the pineal gland, which is inactive during daylight hours. 

“As the sun goes down, darkness activates the pineal, and melatonin production begins,” according to the National Sleep Foundation. “As melatonin levels in the blood rise, you also become less alert—and sleepy. The next morning, melatonin decreases and alertness replaces the sleepiness.”

So the drug seems to put you to sleep without giving you a hangover. But researchers now have a lot of cautionary notes about melatonin. 

For one thing, artificial lights can prevent the night-time release of melatonin. “So it may actually worsen your performance if taken at the wrong time,” the Mayo Clinic’s Dr. Virk cautions. “And as an over-the-counter ‘drug,’ it can contain impurities that could be harmful.”

Now the medical consensus is that melatonin isn’t considered reliable as a hypnotic to induce sleep, but is useful for adjusting your body clock.

But whether melatonin is all that good depends on the traveler who has taken it. Some think it works while others are skeptics.

“I used melatonin for a while,” a former financial analyst with Smith Barney and international traveler says, “but it made me feel buzzy the next day.”

The solution? About the time he was fed up with melatonin, British Airways upgraded service on one of his favorite business routes—between New York and London. It began serving a rather fancy pre-boarding dinner at JFK for first and business class passengers. “So I stopped the melatonin and had dinner on the ground,” he says. “I’d get to the airport a little earlier, have a classy meal, then board and go to bed after a few drinks and sleep for most of the seven-hour flight.” 

Ad-libbing with Pills

Left to improvise—without first-class in-flight amenities—most travelers take a sedative to go to sleep and a caffeine pill to wake up, according to researchers. But in the makeshift world of jet lag remedies, even pill therapy has been changing, partly based on the results of new tests.

While the pharmaceutical industry has paid only moderate attention to the jet lag phenomenon, three so-called hypnotic pills or sedatives—Ambien, Lunesta and Sonata—have become saviors for jet plagued travelers.

The leader is Ambien (zolpidem), despite a flurry of reports earlier this year about strange (and rare) side effects such as sleep-driving. The sedative is the only one tested for jet lag—and compared with melatonin—and seems to be the pill du jour for jet laggers these days, according to the Mayo Clinic’s Dr. Virk.

“It’s effective in decreasing jet lag when taken for a long night flight,” she says, “but it does carry some risk of drowsiness and other side effects during the day.”

Medical Tradeoffs

In the new medical approach that treats jet lag holistically as a disturbance that’s part of your total system, researchers point out that there’s a tradeoff between taking sedatives and getting up to exercise while flying. The one may combat insomnia while the other may be necessary to prevent blood clotting that may be partly caused by tight seating.

“How can you pop a sedative and sleep when you need to walk around to forestall deep-vein thrombosis—especially in coach class?” says Professor David O. Freedman, who runs the travel clinic at the University of Alabama, which caters to a broad cross section of business and leisure travelers. 

Yet another familiar criticism is that those sedatives do leave you drowsy, in varying degrees, after landing. Dr. Freeman thinks that a new pill that is quickly catching on—medafinil or Provigil—seems to effectively induce sleep without aftereffects. 

Near-foolproof Regimen

Professor Eastman, director of Rush University’s Biological Rhythms Research Lab, provides a near-100 percent guarantee you won’t suffer from jet lag on, say, a New York-Rome flight if you follow the methodology she has developed. It’s a scenario laid out in intricate detail in her academic paper on biological rhythms published earlier this year. 

Here’s how it works on a Rome flight: You reset your body clock closer and closer to Italian time—which is six hours off New York time—by taking small doses of melatonin for three days before flight time and going to bed an hour earlier each day. You also combine that procedure with intermittent bright light, natural or artificial (preferably from a light box, widely used to treat the “winter blues”), before boarding. When you arrive in Rome, you can hit the ground walking, if not running, with a clear head, Dr. Eastman says.

“People come to me who’ve had bad jet lag,” she says.  “I’ll lend them a light box—or they can rent one. One time I made up a schedule for a symphony orchestra that went on a trip to Japan—and it worked.”

The problem, of course, is that most business travelers lead such complicated lives—catching flights, checking in and out of hotels, spending evenings doing homework on the road—that they rarely have the time or discipline to follow such a detailed anti-jet lag scenario.

That’s particularly true when they’re moving from foreign city to foreign city with the complexities of adapting to local customs and keeping appointments when addresses may be obscure.

Dr. Virk notes that business travelers on brief visits to, say, China often have to plunge into meetings without sufficient time to recuperate. Their focus on the business problems at hand may be so intense that the aftereffect of a long jet flight becomes negligible.   

The Nap/Caffeine Cocktail

If you want to feel better about your jet lag problem—with a bit of schadenfreude—listen to Dr. Mark Rosekind, president and chief scientist (sic) of Alertness Solutions, as he sizes up the amateur solutions of many professional travelers—like airline pilots.

“Airline captains are the master jet laggers,” he says.  “There’s a lot of science about sleep deprivation, but nobody is using it. We’ve done surveys of pilots to see how they manage alertness. They’re not doing the stuff that works. They’re using things they think work.”

So, what is Dr. Rosekind’s strategy for conquering jet lag?  His remedy is startlingly traditional.

“When I was at NASA, we did a study involving 26-minute naps,” he says. “And we found they boosted performance by 34 percent and alertness by 54 percent. Naps of less than a half hour work.”

“Combining a nap and caffeine is better than using them separately, if you can believe it,” he goes on to explain. “It takes 15 to 30 minutes for caffeine to kick in. So you do the two together. All it takes is a cup of coffee—not even a pill. By the time the caffeine is working, your nap is over.”

Keeping Pilots and Athletes Awake

In any case, Alertness Solutions has worked closely with JetBlue, developing a program for pilots that diagnoses their sleeping styles and helps them make adjustments. For instance, a pilot may get only five solid hours of sleep during a nine-hour sleep period.

With improved diet and exercise, the pilot can have a more restful sleep during a shorter period. The modifications have been so successful with captains that JetBlue is opening the program to flight attendants.

Jet lag, in fact, is a critical problem not only for pilots but also for professional and amateur athletes who, of course, change time zones to play “away” games or perform at international meets.

“A proper amount of sleep can boost an athlete’s performance as much as 30 percent,” Dr. Rosekind says. 

A year ago Alertness Solutions worked with Hilton Hotels to improve sleeping quarters for American athletes at the Olympic Winter Games in Italy. The enhancements, both traditional and high-tech, included clever lighting, sleep-inducing mattresses, temperature controls and easy-to-set alarm clocks—a relief for athletes who are chronically anxious about waking up on time.

The 24/7 Workaholic Style

Companies are no longer looking the other way when it comes to repairing the disconnect between flying fatigue and work patterns. An employee battered by in-flight cabin fever is simply less productive in normal corporate situations, from cubicles to corner offices.

It’s now clear that too much jet lag—and old-fashioned wear and tear on the road—can impact work performance.

“The problem is how you manage people with a global 24/7 lifestyle,” says Dr. Martin Moore-Ede, CEO of Circadian Technologies and a former Harvard Medical School professor. His firm treats jet lag as one of the aspects of the new workaholic mode where sleep disorders and job fatigue interfere with employee performance and productivity.

Circadian Tech believes there are several key behavioral styles that partly determine a person’s ability to adapt to different time zones, Dr. Moore-Ede says. “Are you a morning or evening person?” he says. “Are you a short sleeper—five hours is enough—or a long sleeper?  Are you a napper or a consolidated sleeper who has one sleep in a 24-hour period? Do you sleep only on a timetable or are you flexible?”

Zonked at a Global Meeting?

“Based on the kind of person you are, we can develop a strategy to maximize your capacity to function well after a long flight,” he says. “We call it ‘journey management.’  That’s the big new trend where controlling jet lag comes into play.”

For example, when companies pull in staff from all over the world for a project—it could be a meeting in Scottsdale, Arizona; or Singapore—Moore-Ede’s company will coordinate the trips and provide advice to help make sure everyone is on their toes when they arrive.

“Jet lag may be largely sleep disruption,” Dr. Moore-Ede says, “but it’s really a complex mixture of being out of sync with your normal behavioral patterns, plus other factors that may even include airline food. If you’re going to be abroad for only a few days, why fool around with bright-light solutions? If you keep resetting your body clock, you end up scrambling your orientations.”

“There are accidents,” adds Dr. Rosekind of Alertness Solutions in a reality check of resetting internal time clocks. “You can arrive in London and find you’re on Tokyo time—in terms of circadian rhythms.”