Approach
Medical, sleep, and psychiatric histories are sufficient for the diagnosis of circadian rhythm sleep-wake disorders.
Clinical evaluation
A thorough sleep history is important in the diagnosis of circadian rhythm sleep-wake disorders. In the absence of a previous history of sleep disorders with a history of transmeridian travel, the diagnosis of jet lag disorder is usually straightforward. To make the diagnosis, jet travel across at least 2 time zones is essential.[1] The main complaint of the patient will be either insomnia or daytime sleepiness. Westward travel is associated with difficulty maintaining sleep and eastward travel with difficulty falling asleep.[1] The patient may also complain of impairment of daytime function, general malaise, muscle cramps, or somatic symptoms, such as GI disturbance, within 1-2 days of travel.[1]
A thorough history should differentiate the symptoms of jet lag from travel-related fatigue. Symptoms of travel-related fatigue include general fatigue, increased predisposition to headaches, and travel weariness. Travel fatigue is associated with any long journey and does not require travel across different time zones. It usually abates by the next day after a normal night's sleep.[4]
If the patient has predominant GI or urinary symptoms, an underlying medical condition needs to be ruled out. If a thorough history has been performed and the physical examination is unrevealing, the patient should be reassured about the self-limiting nature of jet lag, and no further testing or follow-up is necessary.
Tests
Frequent travellers with risk factors for obstructive sleep apnoea, which include snoring, obesity, and daytime sleepiness, should have a diagnostic polysomnogram, because a combination of poor sleep and obstructive sleep apnoea can worsen the symptoms of jet lag.
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