Approach

The aim of the treatment is to realign the body's circadian rhythms with the new time zone. Assisting the readjustment of the circadian rhythm may be attempted using natural light.[6] Artificial light and melatonin are possible additional treatments for patients showing moderate to serious symptoms, regardless of the direction of travel.​[2][5][6]​​​[7]​​​

Modification of light exposure and schedule

People with short stays in the new time zone (2 days or fewer) should be encouraged to keep their time schedule in the new time zone as similar as possible to their home schedule to avoid rebound symptoms when they return.[5][8]​​ Those with long durations of stay in the new time zone (>3 days) should be encouraged to take measures to entrain their circadian rhythm to the new time zone as quickly as possible. For a few days before the initiation of travel, they should try to readjust their mealtimes and sleep-wake schedules closer to the new time zone.[5]

Patients travelling eastward need to phase-advance. This can be achieved by avoiding light exposure during the evening and encouraging early morning light exposure before travel.[6] Wearing sunglasses during evening hours should be advised.[2]​ Patients travelling westward need to phase-delay. This can be achieved by light exposure during the evening and avoiding early morning exposure to light. Wearing sunglasses during morning hours should be advised.

Artificial light is indicated as a possible additional treatment for patients showing moderate to serious symptoms, regardless of the direction of travel.[5]​ This suggestion follows a trial where participants received 3 hours of bright (3000 lux) light exposure from head-mounted goggles.[9]

Melatonin

Exogenous melatonin can be used for shifting circadian rhythm.[6][8][10][11]​​​​ Repeated evening melatonin doses have been shown to assist re-adaptation to night sleep after simulated jet lag even in the presence of conflicting bright light treatment; melatonin improved sleep, mood, and memory.[5][11][12][13][14][15][16]​​​

Sedatives/hypnotics

Short-term hypnotics might be tried for insomnia associated with jet lag.​[8][11][17]​​​ The hypnotic zolpidem given for 3 consecutive nights, starting with the first night's sleep at the new destination, has been shown to improve sleep in some travellers.[11][18]​ Short-acting benzodiazepines can also be used; however, their use with alcohol has the risk of causing amnesia during a flight. One study showed improved sleep quality following eastward travel with temazepam.[19] There is a risk of rebound insomnia after discontinuation of the sedatives/hypnotics.

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