We live in an age of adventure; we can visit countries we never thought possible. While some patients may be traveling for fun, many patients travel internationally, racking up air miles. These long trips can cause the miserable feeling of jet lag.

We all know the feeling of fatigue and malaise that accompanies the disorder. It is ironic that those suffering from jet lag may be the very people who are responsible for getting us where we are going: the pilots and flight attendants.

According to the International Classification of Sleep Disorders,1 the following criteria must be met for a patient to be diagnosed with jet lag:

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Complaint of insomnia or excessive daytime sleepiness, accompanied by a reduction of total sleep time, associated with transmeridian jet travel across at least two time zones

  • Associated impairment of daytime function, general malaise, or somatic symptoms (e.g., gastrointestinal disturbance) within one to two days after travel
  • Sleep disturbance is not better explained by another current sleep disorder, medical or neurological disorder, mental disorder, medication use, or substance use disorder
  • Jet lag occurs when there is a change in the endogenous circadian rhythm caused by a change in time zones and may be related to melatonin dysregulation. This can range in severity depending on how many time zones have been crossed.

Other symptoms can include impaired alertness, reduced cognitive skills, and depressed mood. Eastward travel is considered the most difficult because of the required advancing of the sleep-wake cycle. Westward travel can cause sleepiness in the evenings when we would normally be otherwise sleeping.

Other factors that can make jet lag worse includes the discomfort of travel from sitting in confined spaces, air quality, alcohol consumption and pressure changes. The exposure to light changes and darkness can also cause shifts in circadian rhythms that add to the problem.

The good news is that jet lag is a temporary problem — unless your patient is constantly changing time zones. Research suggests that it takes about one day per time zone to adjust. Melatonin has been proven to be highly effective in the treatment of jet lag.

In a placebo-controlled clinic trial, for eastbound flights over eight time zones, melatonin 5mg was administered at 6:00 pm three days prior to flying and at 11:00 pm for four days following the destination of the flight.  There was significant reduction in symptoms using this method.

Ramelteon (Rozerem), a melatonin receptor agonist, has also been studied and found to be effective at 1mg to 8mg administered five minutes before bedtime (local destination time) for four nights with significant decrease in sleep latency compared with placebo.2

Consider melatonin or ramelteon for your patients who travel frequently. They will be happy that you helped make their vacation a success!

Sharon M. O’Brien, MPAS, PA-C, is a practicing clinician with an interest is helping patients understand the importance of sleep hygiene and the impact of sleep on health.


  1. American Academy of Sleep Medicine. (2014). (3rd eds.) International Classification of Sleep Disorders. Darien, IL: American Academy of Sleep Medicine, 2014.
  2. Srinivasan V et al. Melatonin and Melatonergic Drugs in Clinical Practice. 2014; doi: 10.1007/978-81-322-0825-9