Advancing circadian rhythms before eastward flight: a strategy to prevent or reduce jet lag

Sleep and biorhythm among intercontinental pilots: the effect of exempting flight crews from mandatory layover and flight times during COVID-19

Pilots are crucial to the safety of the airline industry; as a result, their sleep and biorhythm, which are closely related to fatigue, play an important role. During the COVID-19 pandemic, the Civil Aviation Administration of China exempted flight crews from mandatory layovers and imposed limitations on duty period and flight times. Given that the effect of this policy on their sleep and biorhythm is poorly understood, this study explores the key factors affecting the sleep and biorhythm of pilots on intercontinental flights and compares the rest status on and after flying days on exempt and non-exempt flights. Eighty pilots flying from China to five countries wore a body movement recorder, which has been validated for estimating total sleep time, sleep efficiency, and interdaily stability. The results of the K-means clustering analysis showed differences in sleep and biorhythm on flying days between departures during the day and at night, west-east and north-south flights, and exempt and non-exempt flights. ANOVA was performed based on the categorization in which each indicator contributed significantly to the clustering (p = 0.000). This study contributes to the literature by validating a new intercontinental flight operation model under the COVID-19 pandemic conditions and proposes critical points for the future management of pilot fatigue on long-haul flights.

Fatigue risk assessment for flight crews flying across time zones in different directions to the east or west during the COVID-19 pandemic in China

BACKGROUND

There is a lack of data support and scientific validation of the Exemption Approach policy for responding to the COVID-19 pandemic, in terms of protecting the health of flight crews and meeting the requirements for passenger and cargo transportation in emergencies, in terms of its safety and the circumstances that contribute to pilots' symptoms of jet lag and the risk of fatigue.

METHODS

To assess pilots' sleep issues related to jet lag symptoms and fatigue, this study evaluated an example of risk management for flight crews on flights across time zones during the COVID-19 pandemic. To evaluate the crew's sleep status, variations in sleep index changes between before and after the flights, variations in sleepiness levels, and data on sleep indexes recorded by ActiGraph bracelets were collected from 146 crew members before and after flights eastward or westward across time zones. Sleepiness levels predicted by applying the SAFE model were also determined.

RESULTS

Whether flying east or west across time zones, the crew's sleep indexes were relatively similar at the end of a flight during a layover. However, a comparison with the pre-flight period showed that the sleep indexes of the crew were slightly more disturbed after the eastward flight compared with those after the westward one. In addition, the SAFE model predicted a higher rate of change in crew mean sleepiness levels between before and after the flight for the eastward flight than for the westward one; however, the Karolinska Sleepiness Score (KSS) of the pilots on either eastward or westward flights did not exceed 5 ("not alert or sleepy").

CONCLUSION

Flight crew adaptation to the Exemption Approach policy during the COVID-19 pandemic was assessed by evaluating the sleep problems of crews flying eastward or westward across time zones.

Delaying early morning workouts to protect sleep in two-a-day athletes

Two-a-day training is common for endurance athletes with training sessions typically beginning at 6 a.m. and 3 p.m. or 4 p.m. However, the early morning workouts could contribute to significant sleep loss, especially for night owls. Chronic sleep loss over a season could result in impaired performance, as well as an increased risk of physical and mental illness. It is hypothesized that shifting the early morning workout to later in the day could have beneficial effects for these athletes. A number of obstacles could make this hypothesis difficulty to test and implement. However, such a change could have dramatic benefits for some athletes.

Gradual Advance of Sleep-Wake Schedules Before an Eastward Flight and Phase Adjustment After Flight in Elite Cross-Country Mountain Bikers: Effects on Sleep and Performance

ABSTRACT

Garbellotto, L, Petit, E, Brunet, E, Guirronnet, S, Clolus, Y, Gillet, V, Bourdin, H, and Mougin, F. Gradual advance of sleep-wake schedules before an eastward flight and phase adjustment after flight in elite cross-country mountain bikers: effects on sleep and performance. J Strength Cond Res 37(4): 872-880, 2023-Strategies, for alleviating jet lag, specifically targeted to competitive athletes have never been studied, in ecological conditions. This study aimed to assess the effects of a phase advance before a 7-hour eastward flight followed by a strategy of resynchronization at destination on sleep and physical performance in professional mountain bikers. Six athletes participated in this study divided into 4 periods: (i) baseline (usual sleep-wake rhythm); (ii) phase advance (advance sleep-wake schedules of 3 hours for 6 days); (iii) travel (flight: Paris-Tokyo); and (iv) phase adjustment (resynchronization of sleep-wake schedules). Melatonin pills and light therapy were administrated during the phase advance and phase adjustment. Sleep was recorded by polysomnography and actigraphy, core body temperature (CBT) rhythm was assessed by ingestible capsules, and physical performances were tested by the Wingate and 5-minute maximal exercise tests. Results showed that bedtime was advanced by 2.9 hours at the end of the phase advance ( p ≤ 0.01) with a batyphase of CBT advanced by 2.5 hours ( p = 0.07). Bedtime was similar at destination compared with baseline. Total sleep time and sleep composition were unchanged at the end of the phase advance or at destination, compared with baseline. Physical performances were maintained after phase advance and at destination. The phase advance enabled to preshift part of the time zones without disturbing sleep and physical performances and contributed to preserving them once at destination. A phase advance before eastward travel represents an effective strategy to counter harmful effects of jet lag.

Travel across time zones and the implications for human performance post pandemic: Insights from elite sport

Notwithstanding technological innovation, the COVID-19 pandemic, and new communication tools, the need for travel is growing again and, in some travel segments, it is stronger than ever. Interestingly, the public health implications of traveling across time zones are still poorly understood and this is especially true for organizations that send their workers across the globe. Using data from 173 Olympic teams over 15 Olympic Games, we show that crossing multiple time zones has negative implications for human (sports) performance. More importantly, the results indicate that performance impairment is especially visible after flying east, with peak performance particularly impaired, leading to a "gold demotion effect" of gold medals to silver medals as a result. Given that Olympic sporting teams typically have dedicated medical staff and active mitigation strategies, these findings have important public health implications. For example, organizations are demanding their workers to be on "top of their game" while traveling, without providing them with the support and tools to do so. The implications for public health management and human resource management are discussed.

Dim light melatonin onset following simulated eastward travel is earlier in young males genotyped as PER35/5 than PER34/4

Inter-individual variability exists in recovery from jetlag following travel across time zones. Part of this variation may be due to genetic differences at the variable number tandem repeat (VNTR) polymorphism of the PERIOD3 (PER3) gene as this polymorphism has been associated with chronotype and sleep, as well as sensitivity to blue light on melatonin suppression. To test this hypothesis we conducted a laboratory-based study to compare re-entrainment in males genotyped as PER3^4/4 (n = 8) and PER3^5/5 (n = 8) following simulated eastward travel across six time zones. The recovery strategy included morning blue-enriched light exposure and appropriately-timed meals during the first 24 h after simulated travel. Dim light melatonin onset (DLMO), sleep characteristics, perceived sleepiness levels (Stanford Sleepiness Scale), and resting metabolic parameters were measured during constant routine periods before and after simulated travel. While DLMO time was similar between the two groups prior to simulated eastward travel (p = .223), it was earlier in the PER3^5/5 group (17h23 (17h15; 17h37)) than the PER3^4/4 group (18h05 (17h53; 18h12)) afterwards (p = .046). During resynchronisation, perceived sleepiness and metabolic parameters were similar to pre-travel in both groups but sleep was more disturbed in the PER3^5/5 group (total sleep time: p = .008, sleep efficiency: p = .008, wake after sleep onset: p = .023). The PER3 VNTR genotype may influence the efficacy of re-entrainment following trans-meridian travel when blue-enriched light exposure is incorporated into the recovery strategy on the first day following travel.

Running on Empty: Self-Reported Sleep/Wake Behaviour during Ultra-Marathon Events Exceeding 100 Miles

The aim of this study was to examine sleep/wake behaviour and sleep strategies before, during and after ultra-marathon running events exceeding 100 miles (161 km). A total of 119 athletes completed a web-based questionnaire regarding their habitual sleep/wake behaviour before, during, and after ultra-marathon participation. Event-specific data were grouped by race distance categories; 100–149 miles (161–240 km), 150–199 miles (241–321 km), and ≥200 miles (322 km). Athletes commonly reported not sleeping throughout the duration of their races (74%). However, for events that were ≥200 miles, athletes reported more sleep opportunities, longer sleep duration, and more total sleep when compared to events that were 100–149 miles in distance (p ≤ 0.001). This suggests that for races of shorter distances, the benefit of continuous racing outweighs the negative impact of continuous wakefulness/sleep deprivation. However, for longer races (≥200 miles), there is an apparent tradeoff between sleep deprivation and race strategy, whereby athletes cannot sustain a desired level of performance without obtaining sleep. This is consistent with established sleep/wake behaviour models suggesting that sleep need increases as wakefulness increases, or in this case, as race duration increases. For athletes participating in ultra-marathons, sleep management education and/or consultation with a sleep scientist prior to racing may be beneficial. Future research should examine the optimal strategies concerning the frequency and duration of sleep during ultra-marathons and the subsequent impact on performance.

Effect of circadian system disruption on the concentration and daily oscillations of cortisol, progesterone, melatonin, serotonin, growth hormone, and core body temperature in periparturient dairy cattle

Metabolic, circadian, sleep, and reproductive systems are integrated and reciprocally regulated, but the understanding of the mechanism is limited. To study this integrated regulation, the circadian timing system was disrupted by exposing late pregnant nonlactating (dry) cows to chronic shifts in the light-dark phase, and rhythms of body temperature and circulating cortisol (CORT), progesterone (P4), serotonin (5HT), melatonin (MEL), and growth hormone (GH) concentrations were measured. Specifically, across 2 identical studies (1 and 2), at 35 d before expected calving (BEC) multiparous cows were assigned to control (CON; n = 24) and exposed to 16 h light and 8 h dark or phase shift (PS; n = 24) treatments and exposed to 6-h light-dark phase shifts every 3 d until parturition. All cows were exposed to control lighting after calving. Blood samples were collected in the first study at 0600 h on d 35 BEC, d 21 BEC, and 2 d before calving, and d 0, 2, 9, 15, and 22 postpartum (PP). A subset of cows (n = 6/group) in study 1 was blood sampled every 4 h over 48 h beginning on d 23 BEC, 9 BEC, and 5 PP. Body temperature was measured every 30 min (n = 8-16/treatment) for 48 h at 23 BEC and 9 BEC in both studies; and at 14 PP and 60 PP only in study 2. Treatment did not affect levels of CORT, GH, or P4 at 0600 h, but overall level of 5HT was lower and MEL higher in PS cows across days sampled. A 2-component versus single-component cosinor model better described [>coefficient of determination (R²); <Akaike information criterion and <Bayesian information criterion] daily oscillations of all hormones and temperature for both treatments. Circadian rhythm fit (R²) of body temperature and MEL increased from 23 BEC to 9 BEC in CON and was marked by loss of feeding time influence on oscillations in both treatments. Both treatments exhibited circadian rhythms of CORT at 9 BEC, CON cows also exhibited circadian rhythms in P4 at 23 BEC, and 5HT at 9 BEC. Daily oscillations in temperature and hormones, except CORT, were affected by PS treatment in the prepartum and were associated with longer gestation. In the PP, circadian rhythmicity was lost or diminished for all hormones and body temperature in both treatments. Stronger rhythms of body temperature and multiple hormones at 1 wk prepartum may indicate a synchronizing cue to time parturition. Therefore, dairy systems may need to consider management factors that affect circadian clocks in late-gestation cows.

Marathon run performance on daylight savings time transition days: results from a natural experiment

Advancing clock times by 1 h in the spring to daylight savings time and setting clock times back 1 h in the autumn to standard time disrupts circadian timing, sleep and skilled motor behavior such as driving an automobile. It is unknown if endurance performance is impacted by daylight savings transition (DST). The natural experiment described here examined whether exposure to a DST in the 10 h prior to the start of a marathon race was associated with a different mean completion time compared to participants who ran the same course but were unexposed to a recent DST. The primary outcome was the average running time of finishers of United States marathons that were completed on either spring-DST or autumn-DST days in the years 2000-2018. Comparisons were made to results from the same marathon held in a different year that was not run on a DST day. Data were obtained from the public data base marathonguide.com/results. Analysis of the primary outcome used paired samples t-tests weighted by sample size. Spring and autumn data were analyzed separately. Eighteen spring and 29 autumn marathons met the inclusion criteria. Compared to control marathons, the weighted spring-DST performance was worse by 12.3 min (4.1%; P < .001) and equal to a moderate standardized effect size of 0.57 while autumn-DST was trivially worse by 1.4 min (0.5%), which was equivalent to an effect size of 0.13. Ambient temperatures for the DST and control races did not differ for either the spring (10.6 vs. 8.9℃; P = .212) or autumn marathons (7.6 vs. 9.3℃; P = .131). Within the limitations of a natural experiment research design, it is concluded that the findings support worse running performance in marathon races held in the spring on the day of transition to daylight savings time when there is a forced circadian change and sleep loss.

Chronic jetlag-induced alterations in pancreatic diurnal gene expression

Cell-autonomous circadian clocks exist in nearly every organ and function to maintain homeostasis through a complex series of transcriptional-translational feedback loops. The response of these peripheral clocks to external perturbations, such as chronic jetlag and shift work, has been extensively investigated. However, an evaluation of the effects of chronic jetlag on the mouse pancreatic transcriptome is still lacking. Herein, we report an evaluation of the diurnal variations encountered in the pancreatic transcriptome following exposure to an established chronic jetlag protocol. We found approximately 5.4% of the pancreatic transcriptome was rhythmic. Following chronic jetlag, we found the number of rhythmic transcripts decreased to approximately 3.6% of the transcriptome. Analysis of the core clock genes, which orchestrate circadian physiology, revealed that nearly all exhibited a shift in the timing of peak gene expression-known as a phase shift. Similarly, over 95% of the rhythmically expressed genes in the pancreatic transcriptome exhibited a phase shift, many of which were found to be important for metabolism. Evaluation of the genes involved in pancreatic exocrine secretion and insulin signaling revealed many pancreas-specific genes were also rhythmically expressed and several displayed a concomitant phase shift with chronic jetlag. Phase differences were found 9 days after normalization, indicating a persistent failure to reentrain to the new light-dark cycle. This study is the first to evaluate the endogenous pancreatic clock and rhythmic gene expression in whole pancreas over 48 h, and how the external perturbation of chronic jetlag affects the rhythmic expression of genes in the pancreatic transcriptome.

How do travelers manage jetlag and travel fatigue? A survey of passengers on long-haul flights

Jetlag and travel fatigue can impair functioning, but it is unknown what strategies are used by travelers to minimize these consequences. Passengers on Qantas Airways flights were invited to take part in online surveys. Long-haul flights of ≥8 h into and out of Australia were targeted, which involved time differences of 1 to 18 h between the origin and destination. Passengers were queried about the use of travel booking choices before the flight, and the use of behavioral strategies before, during, and after flight for reducing jetlag and travel fatigue. Surveys were completed by N = 460 passengers aged 18 to 78 (43% male; mean age 50 y). Selecting a seat location (59%) and choosing a direct flight (52%) were the most common booking strategies. Almost all (99%) employed specific behavioral strategies during flight, with fewer implementing strategies before flight (73%) and after flight (89%). During the journey, 81% consumed or avoided caffeine and alcohol, 68% altered food intake, 68% used comfort/relaxation strategies, 53% light exposure, 35% physical activity, 31% compression stockings, 15% pharmaceutical sleep aids, and 8% melatonin. Surprisingly, only 1 of 460 passengers reported using a jetlag app. Younger travelers were more likely to adopt any strategy before the flight than older travelers (χ ² ₂ = 14.90, p =.01), while female travelers appeared more likely than male travelers to use strategies before (77% vs. 68%) and after flight (91% vs. 85%). Reason for travel, flight cabin, leg of journey, and country of residence were not significantly associated with the use of behavioral strategies. Nearly all passengers took measures to improve the experience and consequences of long-haul flying. The results suggest that interventions around food/drink and physical activity may be highly acceptable to passengers for mitigating travel fatigue and that greater public education on evidence-based strategies may be helpful for reducing travel fatigue and jetlag.

Circadian Phase Advances in Response to Weekend Morning Light in Adolescents With Short Sleep and Late Bedtimes on School Nights

Many adolescents fall asleep too late to get enough sleep (8-10 h) on school nights. Morning bright light advances circadian rhythms and could help adolescents fall asleep earlier. Morning bright light treatment before school, however, is difficult to fit into their morning schedule; weekends are more feasible. We examined phase advances in response to morning light treatment delivered over one weekend. Thirty-seven adolescents (16 males; 14.7-18.0 years) who reported short school-night sleep (≤7 h) and late bedtimes (school-nights ≥23:00; weekend/non-school nights ≥24:00) slept as usual at home for ∼2 weeks ("baseline") and then kept a fixed sleep schedule (baseline school-night bed and wake-up times ±30 min) for ∼1 week before living in the lab for one weekend. Sleep behavior was measured with wrist actigraphy and sleep diary. On Saturday morning, we woke each participant 1 h after his/her midpoint of baseline weekend/non-school night sleep and 1 h earlier on Sunday. They remained in dim room light (∼20 lux) or received 1.5 or 2.5 h of intermittent morning bright light (∼6000 lux) on both mornings. The dim light melatonin onset (DLMO), a phase marker of the circadian timing system, was measured on Friday and Sunday evenings to compute the weekend circadian phase shift. The dim room light and 1.5-h bright light groups advanced the same amount (0.6 ± 0.4 and 0.6 ± 0.5 h). The 2.5-h bright light group advanced 1.0 ± 0.4 h, which was significantly more than the other groups. These data suggest that it is possible to phase advance the circadian clock of adolescents who have late bedtimes and short school-night sleep in one weekend using light that begins shortly after their sleep midpoint.

Out of your zone? 21 years of travel and performance in Super Rugby

The extent to which travel has affected Super Rugby teams' performances was analysed using outcomes of all matches played from the beginning of the competition in 1996 to the end of the 2016 season. Points difference and matches won or lost were predicted with general and generalized mixed linear models. The predictors were the linear effects of number of time zones crossed and travel duration based on the teams' locations for each match and their locations in the previous week. The away-match disadvantage was also estimated, along with trends in all these effects. In 1996 the predicted combined effect of eastward travel across 12 time zones was a reduction of 5.8 points scored per match, resulting in 4.1 more matches lost every 10 matches. Corresponding effects for westward travel were 6.4 points and 3.1 matches. In 2016 effects travelling eastward were 3.7 points and 2.3 matches, whereas travelling westward the effects were 3.7 points and 1.5 matches. These travel effects were due mainly to the away-match disadvantage: 5.7 points and 3.2 matches in 1996; 5.2 points and 2.3 matches in 2016. Teams in Super Rugby are dealing successfully with long-haul travel and should now focus on reducing the away-match disadvantage.

The elite athlete as a special risk traveler and the jet lag's effect: lessons learned from the past and how to be prepared for the next Olympic Games 2020 Tokyo

BACKGROUND

Elite athletes have to travel long-haul distances and cross multiple meridians; thus, a unique syndrome named as jet-lag is induced. Furthermore, traveler athletes are submitted to several factors negatively affecting their well-being and athletic performance. This qualitative descriptive study aims to promote safely and future promising participations of elite athletes in great events, such as the next Olympic Games 2020 Tokyo, based on the chronobiology of jet-lag, factors affecting the traveler athlete and previous experiences from the 2014 FIFA World Cup Brazil, the 2018 FIFA World Cup Russia and the Olympic Games Rio 2016.

METHODS

A narrative review of the literature across a broad cross-section of the chronobiology of jet-lag and factors affecting the traveler athlete was undertaken. In addition, a general analysis based on the past sport events aforementioned is also included.

RESULTS

The jet-lag disorder may occur after transmeridian travel over more than three time-zones and the resynchronization is dependent on the direction and number of the time-zones crossed and the availability and the intensity of local circadian time cues. Also the athlete's ability to sleep, eat, get hydrated and train, are essential, as well as, others individual tolerance differences, such as age, gender, chronotype and ethnic differences. Athletes should arrive a number of days before the competition according to the number of time-zone transitions experienced.

CONCLUSIONS

Jet-lag is usually benign and self-limited, but can occasionally have serious consequences for the athlete's mental and physical health and performance. A good plan concerning the athlete's traveling schedule, sleeping, eating and training before and after travelling is mandatory.

What works for jetlag? A systematic review of non-pharmacological interventions

Jetlag is a combination of travel fatigue and circadian misalignment resulting from air travel across time zones. Routinely recommended interventions based on circadian science include timely exposure to light and darkness (scheduled sleep), but the real-world effectiveness of these and other non-circadian strategies is unknown. We systematically reviewed the evidence for non-pharmacological interventions for jetlag. PubMed, EMBASE, Scopus, and Web of Science were searched. Studies reviewed 1) involved human participants undergoing air travel with a corresponding shift in the external light-dark cycle; 2) administered a non-pharmacological intervention; 3) had a control or comparison group; and 4) examined outcomes such as jetlag symptoms, sleep, cognitive/physical performance, mood, fatigue, or circadian markers. Thirteen studies used light exposure, physical activity, diet, chiropractic treatment, or a multifaceted intervention to counteract jetlag. Nine studies found no significant change in the outcomes, three reported mixed findings, and one was positive. The null findings are likely due to poorly designed circadian interventions and neglect of contributors to travel fatigue. Higher quality studies that schedule darkness as well as light, in the periods before, during, and after flight are needed to reduce the circadian component of jetlag. Interventions should also address the stressors that contribute to travel fatigue.

Universal method for robust detection of circadian state from gene expression

Circadian clocks play a key role in regulating a vast array of biological processes, with significant implications for human health. Accurate assessment of physiological time using transcriptional biomarkers found in human blood can significantly improve diagnosis of circadian disorders and optimize the delivery time of therapeutic treatments. To be useful, such a test must be accurate, minimally burdensome to the patient, and readily generalizable to new data. A major obstacle in development of gene expression biomarker tests is the diversity of measurement platforms and the inherent variability of the data, often resulting in predictors that perform well in the original datasets but cannot be universally applied to new samples collected in other settings. Here, we introduce TimeSignature, an algorithm that robustly infers circadian time from gene expression. We demonstrate its application in data from three independent studies using distinct microarrays and further validate it against a new set of samples profiled by RNA-sequencing. Our results show that TimeSignature is more accurate and efficient than competing methods, estimating circadian time to within 2 h for the majority of samples. Importantly, we demonstrate that once trained on data from a single study, the resulting predictor can be universally applied to yield highly accurate results in new data from other studies independent of differences in study population, patient protocol, or assay platform without renormalizing the data or retraining. This feature is unique among expression-based predictors and addresses a major challenge in the development of generalizable, clinically useful tests.

Late bedtimes prevent circadian phase advances to morning bright light in adolescents

We examined phase shifts to bright morning light when sleep was restricted by delaying bedtimes. Adolescents (n = 6) had 10-h sleep/dark opportunities for 6 days. For the next 2 days, half were put to bed 4.5 h later and then allowed to sleep for 5.5 h (evening room light + sleep restriction). The others continued the 10-h sleep opportunities (sleep satiation). Then, sleep schedules were gradually shifted earlier and participants received bright light (90 min, ~6000 lux) after waking for 3 days. As expected, sleep satiation participants advanced (~2 h). Evening room light + sleep restriction participants did not shift or delayed by 2-4 h. Abbreviations: DLMO: dim light melatonin onset.

Sleep and Circadian Hygiene and Inflammatory Bowel Disease

There is increasing evidence that sleep and circadian disruption can worsen the disease course in inflammatory bowel disease (IBD). Sleep and circadian disruption are prevalent in society and are associated with worse outcomes in IBD. Emerging research suggests sleep and circadian disruption can impact key components in IBD disease flares, including intestinal permeability, translocation of bacterial endotoxins, intestinal dysbiosis, and proinflammatory cytokines. Much of this research has been conducted in animal models. There is a clear need for large randomized controlled trials in human patients with IBD, where the potential for chronotherapeutic strategies to improve disease course can be tested.

Medications for Sleep Schedule Adjustments in Athletes

Context:

Sleep schedule adjustments are common requirements of modern-day athletes. Many nonpharmacologic and pharmacologic strategies exist to facilitate circadian rhythm shifts to maximize alertness and performance during competition. This review summarizes the evidence for commonly used pharmacologic agents and presents recommendations for the sports medicine provider.

Evidence Acquisition:

MEDLINE searches were performed using the following keywords: sleep aids, circadian rhythm adjustment, athletes and sleep, caffeine and sports, melatonin and athletes, and sleep aids and sports. Pertinent articles were extracted and discussed.

Study Design:

Clinical review.

Level of Evidence:

Level 2.

Results:

There are very few available studies investigating pharmacologic sleep aids in athletes. Data from studies involving shift workers and airline personnel are more abundant and were used to formulate recommendations and conclusions.

Conclusion:

Melatonin, caffeine, and nonbenzodiazepine sleep aids have a role in facilitating sleep schedule changes in athletes and maximizing sports performance through sleep enhancement.

Circadian phase, circadian period and chronotype are reproducible over months

The timing of the circadian clock, circadian period and chronotype varies among individuals. To date, not much is known about how these parameters vary over time in an individual. We performed an analysis of the following five common circadian clock and chronotype measures: 1) the dim light melatonin onset (DLMO, a measure of circadian phase), 2) phase angle of entrainment (the phase the circadian clock assumes within the 24-h day, measured here as the interval between DLMO and bedtime/dark onset), 3) free-running circadian period (tau) from an ultradian forced desynchrony protocol (tau influences circadian phase and phase angle of entrainment), 4) mid-sleep on work-free days (MSF from the Munich ChronoType Questionnaire; MCTQ) and 5) the score from the Morningness-Eveningness Questionnaire (MEQ). The first three are objective physiological measures, and the last two are measures of chronotype obtained from questionnaires. These data were collected from 18 individuals (10 men, eight women, ages 21-44 years) who participated in two studies with identical protocols for the first 10 days. We show how much these circadian rhythm and chronotype measures changed from the first to the second study. The time between the two studies ranged from 9 months to almost 3 years, depending on the individual. Since the full experiment required living in the laboratory for 14 days, participants were unemployed, had part-time jobs or were freelance workers with flexible hours. Thus, they did not have many constraints on their sleep schedules before the studies. The DLMO was measured on the first night in the lab, after free-sleeping at home and also after sleeping in the lab on fixed 8-h sleep schedules (loosely tailored to their sleep times before entering the laboratory) for four nights. Graphs with lines of unity (when the value from the first study is identical to the value from the second study) showed how much each variable changed from the first to the second study. The DLMO did not change more than 2 h from the first to the second study, except for two participants whose sleep schedules changed the most between studies, a change in sleep times of 3 h. Phase angle did not change by more than 2 h regardless of changes in the sleep schedule. Circadian period did not change more than 0.2 h, except for one participant. MSF did not change more than 1 h, except for two participants. MEQ did not change more than 10 points and the categories (e.g. M-type) did not change. Pearson's correlations for the DLMO between the first and second studies increased after participants slept in the lab on their individually timed fixed 8-h sleep schedules for four nights. A longer time between the two studies did not increase the difference between any of the variables from the first to the second study. This analysis shows that the circadian clock and chronotype measures were fairly reproducible, even after many months between the two studies.

[The current state of research in bright light therapy]

The significance of light for the human organism and especially for the mental health is well-established for a long time. Therefore, the impact of light on mood and the use of bright light as a treatment-option for affective disorders have been studied extensively by scientists. Today bright light therapy is the treatment of choice for saisonal affective disorders. In the last years several clinical trials could demonstrate the therapeutic efficacy of bright light therapy for different neurological and psychiatric disorders such as sleep disorders, non-seasonal affective disorders or dementia. This article will give an overview about the neurobiological basis for light therapy and discuss different disorders responsive to light therapy. Finally a short overview about technical aspects of light therapy and new developments in light engineering will be presented.

Temporal integration of light flashes by the human circadian system

BACKGROUND

Beyond image formation, the light that is detected by retinal photoreceptors influences subcortical functions, including circadian timing, sleep, and arousal. The physiology of nonimage-forming (NIF) photoresponses in humans is not well understood; therefore, the development of therapeutic interventions based on this physiology, such as bright light therapy to treat chronobiological disorders, remains challenging.

METHODS

Thirty-nine participants were exposed to 60 minutes of either continuous light (n = 8) or sequences of 2-millisecond light flashes (n = 31) with different interstimulus intervals (ISIs; ranging from 2.5 to 240 seconds). Melatonin phase shift and suppression, along with changes in alertness and sleepiness, were assessed.

RESULTS

We determined that the human circadian system integrates flash sequences in a nonlinear fashion with a linear rise to a peak response (ISI = 7.6 ± 0.53 seconds) and a power function decrease following the peak of responsivity. At peak ISI, flashes were at least 2-fold more effective in phase delaying the circadian system as compared with exposure to equiluminous continuous light 3,800 times the duration. Flashes did not change melatonin concentrations or alertness in an ISI-dependent manner.

CONCLUSION

We have demonstrated that intermittent light is more effective than continuous light at eliciting circadian changes. These findings cast light on the phenomenology of photic integration and suggest a dichotomous retinohypothalamic network leading to circadian phase shifting and other NIF photoresponses. Further clinical trials are required to judge the practicality of light flash protocols.

TRIAL REGISTRATION

Clinicaltrials.gov NCT01119365.

FUNDING

National Heart, Lung, and Blood Institute (1R01HL108441-01A1) and Department of Veterans Affairs Sierra Pacific Mental Illness Research, Education, and Clinical Center.

Evaluation of the Charité Jet Lag Scale

The first German Charité Jet Lag Scale (CJS), based on the only validated English questionnaire, was introduced in a former study. In addition to providing further jet lag investigations, this second method-comparison study aims to evaluate the CJS. Consistent interviewing methods are essential for future research in identifying possible cross-cultural tendencies, advancing jet lag definition, and establishing potential alleviation methods. Jet lag in 17 German chorus members (5 male, 12 female, mean age 42.35 ± 13.06 years) was monitored on their 2½-week trip from Germany to Argentina and back by use of actigraphy, sleep diaries, and the CJS. Cronbach’s alpha, Pearson and Lin correlations, and Bland-Altman diagrams were applied to assess CJS reliability and validity between all measurement methods. CJS study analysis results reconfirmed the prevalence of jet lag at approximately 60%. Moreover, the study assessed high Cronbach’s alpha values and significant positive correlations for several corresponding and related sleep parameters and CJS items such as total sleep time (TST) and sleep onset latency (SOL). The confidence limits in the Bland-Altman diagrams remained within the limits of earlier studies (TST ± 1 h, SOL ± 30 min). Overall, jet lag measures in this study confirmed previous jet lag studies. Evidence indicates positive reliability and validity of the CJS, with lower specificity in some parameters. We conclude that the CJS is applicable for complex jet lag studies. The findings provide support for further development of the scale and its capability as a consistent jet lag interviewing method.

Phase advancing human circadian rhythms with morning bright light, afternoon melatonin, and gradually shifted sleep: can we reduce morning bright-light duration?

OBJECTIVE

Efficient treatments to phase-advance human circadian rhythms are needed to attenuate circadian misalignment and the associated negative health outcomes that accompany early-morning shift work, early school start times, jet lag, and delayed sleep phase disorder. This study compared three morning bright-light exposure patterns from a single light box (to mimic home treatment) in combination with afternoon melatonin.

METHODS

Fifty adults (27 males) aged 25.9 ± 5.1 years participated. Sleep/dark was advanced 1 h/day for three treatment days. Participants took 0.5 mg of melatonin 5 h before the baseline bedtime on treatment day 1, and an hour earlier each treatment day. They were exposed to one of three bright-light (~5000 lux) patterns upon waking each morning: four 30-min exposures separated by 30 min of room light (2-h group), four 15-min exposures separated by 45 min of room light (1-h group), and one 30-min exposure (0.5-h group). Dim-light melatonin onsets (DLMOs) before and after treatment determined the phase advance.

RESULTS

Compared to the 2-h group (phase shift = 2.4 ± 0.8 h), smaller phase-advance shifts were seen in the 1-h (1.7 ± 0.7 h) and 0.5-h (1.8 ± 0.8 h) groups. The 2-h pattern produced the largest phase advance; however, the single 30-min bright-light exposure was as effective as 1 h of bright light spread over 3.25 h, and it produced 75% of the phase shift observed with 2 h of bright light.

CONCLUSIONS

A 30-min morning bright-light exposure with afternoon melatonin is an efficient treatment to phase-advance human circadian rhythms.

Protecting the melatonin rhythm through circadian healthy light exposure

Currently, in developed countries, nights are excessively illuminated (light at night), whereas daytime is mainly spent indoors, and thus people are exposed to much lower light intensities than under natural conditions. In spite of the positive impact of artificial light, we pay a price for the easy access to light during the night: disorganization of our circadian system or chronodisruption (CD), including perturbations in melatonin rhythm. Epidemiological studies show that CD is associated with an increased incidence of diabetes, obesity, heart disease, cognitive and affective impairment, premature aging and some types of cancer. Knowledge of retinal photoreceptors and the discovery of melanopsin in some ganglion cells demonstrate that light intensity, timing and spectrum must be considered to keep the biological clock properly entrained. Importantly, not all wavelengths of light are equally chronodisrupting. Blue light, which is particularly beneficial during the daytime, seems to be more disruptive at night, and induces the strongest melatonin inhibition. Nocturnal blue light exposure is currently increasing, due to the proliferation of energy-efficient lighting (LEDs) and electronic devices. Thus, the development of lighting systems that preserve the melatonin rhythm could reduce the health risks induced by chronodisruption. This review addresses the state of the art regarding the crosstalk between light and the circadian system.

A physiologically based pharmacokinetics model for melatonin--effects of light and routes of administration

Physiologically based pharmacokinetic (PBPK) models were developed using MATLAB Simulink(®) to predict diurnal variations of endogenous melatonin with light as well as pharmacokinetics of exogenous melatonin via different routes of administration. The model was structured using whole body, including pineal and saliva compartments, and parameterized based on the literature values for endogenous melatonin. It was then optimized by including various intensities of light and various dosage and formulation of melatonin. The model predictions generally have a good fit with available experimental data as evaluated by mean squared errors and ratios between model-predicted and observed values considering large variations in melatonin secretion and pharmacokinetics as reported in the literature. It also demonstrates the capability and usefulness in simulating plasma and salivary concentrations of melatonin under different light conditions and the interaction of endogenous melatonin with the pharmacokinetics of exogenous melatonin. Given the mechanistic approach and programming flexibility of MATLAB Simulink(®), the PBPK model could provide predictions of endogenous melatonin rhythms and pharmacokinetic changes in response to environmental (light) and experimental (dosage and route of administration) conditions. Furthermore, the model may be used to optimize the combined treatment using light exposure and exogenous melatonin for maximal phase advances or delays.

Potency of melatonin in living beings

Living beings are surrounded by various changes exhibiting periodical rhythms in environment. The environmental changes are imprinted in organisms in various pattern. The phenomena are believed to match the external signal with organisms in order to increase their survival rate. The signals are categorized into circadian, seasonal, and annual cycles. Among the cycles, the circadian rhythm is regarded as the most important factor because its periodicity is in harmony with the levels of melatonin secreted from pineal gland. Melatonin is produced by the absence of light and its presence displays darkness. Melatonin plays various roles in creatures. Therefore, this review is to introduce the diverse potential ability of melatonin in manifold aspects in living organism.

Circadian rhythm sleep disorders

There have been remarkable advances in our understanding of the molecular, cellular, and physiologic mechanisms underlying the regulation of circadian rhythms, and of the impact of circadian dysfunction on health and disease. This information has transformed our understanding of the effect of circadian rhythm sleep disorders (CRSD) on health, performance, and safety. CRSDs are caused by alterations of the central circadian timekeeping system, or a misalignment of the endogenous circadian rhythm and the external environment. This article reviews circadian biology and discusses the pathophysiology, clinical features, diagnosis, and treatment of the most commonly encountered CRSDs in clinical practice.

Melatonin in the afternoons of a gradually advancing sleep schedule enhances the circadian rhythm phase advance

RATIONALE

We test methods to advance (shift earlier) circadian rhythms without producing misalignment between rhythms and sleep. We previously tested (1) a gradually advancing sleep/dark schedule plus morning bright light and afternoon/evening melatonin and (2) the same sleep schedule with only morning bright light. Now we report on the same sleep schedule with only afternoon/evening melatonin.

OBJECTIVES

This study aims to examine phase advances, sleepiness, and performance in response to melatonin compared to placebo.

METHODS

Twelve adults (five female individuals) aged 20-45 years (mean ± SD = 28.3 ± 7.3 years) completed this within-subjects placebo-controlled counterbalanced study. The participants slept on fixed 8-h sleep schedules for nine days. Then, sleep/dark was advanced by 1 h/day for three consecutive days of treatment. The participants took 3 mg of melatonin or placebo 11 h before baseline sleep midpoint (the optimal time to produce phase advances) on the first treatment day and 1 h earlier on each subsequent day. We measured the dim light melatonin onset before and after treatment. The participants rated subjective symptoms throughout the study. They completed the Psychomotor Vigilance Task and rated sleepiness from 1 h before pill ingestion until bedtime on each treatment day.

RESULTS

Melatonin produced significantly larger advances (1.3 ± 0.7 h) compared to placebo (0.7 ± 0.7 h); however, in the hours between melatonin ingestion and bed, melatonin caused sleepiness and performance decrements.

CONCLUSIONS

Adding afternoon/evening melatonin to the gradually advancing sleep schedule increased the phase advance, but given the side effects, like sleepiness, it is better to use morning bright light and perhaps a lower dose of melatonin.

Effect of airline travel on performance: a review of the literature

The need for athletes to travel long distances has spurred investigation into the effect of air travel across multiple time zones on athletic performance. Rapid eastward or westward travel may negatively affect the body in many ways; therefore, strategies should be employed to minimise these effects which may hamper athletic performance. In this review, the fundamentals of circadian rhythm disruption are examined along with additional effects of airline travel including jet lag, sleep deprivation, travel at altitude and nutritional considerations that negatively affect performance. Evidence-based recommendations are provided at the end of the manuscript to minimise the effects of airline travel on performance.

Circadian disruption and remedial interventions: effects and interventions for jet lag for athletic peak performance

Jet lag has potentially serious deleterious effects on performance in athletes following transmeridian travel, where time zones are crossed eastwards or westwards; as such, travel causes specific effects related to desynchronization of the athlete's internal body clock or circadian clock. Athletes are particularly sensitive to the effects of jet lag, as many intrinsic aspects of sporting performance show a circadian rhythm, and optimum competitive results require all aspects of the athlete's mind and body to be working in tandem at their peak efficiency. International competition often requires transmeridian travel, and competition timings cannot be adjusted to suit individual athletes. It is therefore in the interest of the individual athlete and team to understand the effects of jet lag and the potential adaptation strategies that can be adopted. In this review, we describe the underlying genetic and physiological mechanisms controlling the circadian clock and its inherent ability to adapt to external conditions on a daily basis. We then examine the fundamentals of the various adaptation stimuli, such as light, chronobiotics (e.g. melatonin), exercise, and diet and meal timing, with particular emphasis on their suitability as strategies for competing athletes on the international circuit. These stimuli can be artificially manipulated to produce phase shifts in the circadian rhythm to promote adaptation in the optimum direction, but care must be taken to apply them at the correct time and dose, as the effects produced on the circadian rhythm follow a phase-response curve, with pronounced shifts in direction at different times. Light is the strongest realigning stimulus and careful timing of light exposure and avoidance can promote adjustment. Chronobiotics such as melatonin can also be used to realign the circadian clock but, as well as timing and dosage issues, there are also concerns as to its legal status in different countries and with the World Anti-Doping Agency. Experimental data concerning the effects of food intake and exercise timing on jet lag is limited to date in humans, and more research is required before firm guidelines can be stated. All these stimuli can also be used in pre-flight adaptation strategies to promote adjustment in the required direction, and implementation of these is described. In addition, the effects of individual variability at the behavioural and genetic levels are also discussed, along with the current limitations in assessment of these factors, and we then put forward three case studies, as examples of practical applications of these strategies, focusing on adaptations to travel involving competition in the Rugby Sevens World Cup and the 2016 Summer Olympics in Rio de Janeiro, Brazil. Finally, we provide a list of practice points for optimal adaptation of athletes to jet lag.

WHAT IS "HEALTHY LIGHTING?"

It is well-known that the light/dark cycle incident on the retina regulates the timing of the human circadian system. Disruption of a regular, 24-hour pattern of light and dark can significantly affect our health and well-being. A wide range of modern maladies, from sleep disorders to cancer, have been linked to light-induced circadian disruption. Light has been defined, however, only in terms of the human visual system, not the circadian system. Thus, the study of light-induced circadian disruption is in need of a new definition of light (and dark). Here we contrast light as a stimulus for the human visual system with that for the human circadian system to elucidate the significance of developing a new definition of circadian light as it might ultimately be used to improve health and well-being.

Amplitude reduction and phase shifts of melatonin, cortisol and other circadian rhythms after a gradual advance of sleep and light exposure in humans

BACKGROUND

The phase and amplitude of rhythms in physiology and behavior are generated by circadian oscillators and entrained to the 24-h day by exposure to the light-dark cycle and feedback from the sleep-wake cycle. The extent to which the phase and amplitude of multiple rhythms are similarly affected during altered timing of light exposure and the sleep-wake cycle has not been fully characterized.

METHODOLOGY/PRINCIPAL FINDINGS

We assessed the phase and amplitude of the rhythms of melatonin, core body temperature, cortisol, alertness, performance and sleep after a perturbation of entrainment by a gradual advance of the sleep-wake schedule (10 h in 5 days) and associated light-dark cycle in 14 healthy men. The light-dark cycle consisted either of moderate intensity 'room' light (∼90-150 lux) or moderate light supplemented with bright light (∼10,000 lux) for 5 to 8 hours following sleep. After the advance of the sleep-wake schedule in moderate light, no significant advance of the melatonin rhythm was observed whereas, after bright light supplementation the phase advance was 8.1 h (SEM 0.7 h). Individual differences in phase shifts correlated across variables. The amplitude of the melatonin rhythm assessed under constant conditions was reduced after moderate light by 54% (17-94%) and after bright light by 52% (range 12-84%), as compared to the amplitude at baseline in the presence of a sleep-wake cycle. Individual differences in amplitude reduction of the melatonin rhythm correlated with the amplitude of body temperature, cortisol and alertness.

CONCLUSIONS/SIGNIFICANCE

Alterations in the timing of the sleep-wake cycle and associated bright or moderate light exposure can lead to changes in phase and reduction of circadian amplitude which are consistent across multiple variables but differ between individuals. These data have implications for our understanding of circadian organization and the negative health outcomes associated with shift-work, jet-lag and exposure to artificial light.

Circadian disruption leads to loss of homeostasis and disease

The relevance of a synchronized temporal order for adaptation and homeostasis is discussed in this review. We present evidence suggesting that an altered temporal order between the biological clock and external temporal signals leads to disease. Evidence mainly based on a rodent model of “night work” using forced activity during the sleep phase suggests that altered activity and feeding schedules, out of phase from the light/dark cycle, may be the main cause for the loss of circadian synchrony and disease. It is proposed that by avoiding food intake during sleep hours the circadian misalignment and adverse consequences can be prevented. This review does not attempt to present a thorough revision of the literature, but instead it aims to highlight the association between circadian disruption and disease with special emphasis on the contribution of feeding schedules in circadian synchrony.

Treatment of shift work disorder and jet lag

OPINION STATEMENT

With the growth of the 24-hour global marketplace, a substantial proportion of workers are engaged in nontraditional work schedules and frequent jet travel across multiple time zones. Thus, shift work disorder and jet lag are prevalent in our 24/7 society and have been associated with significant health and safety repercussions. In both disorders, treatment strategies are based on promoting good sleep hygiene, improving circadian alignment, and targeting specific symptoms.Treatment of shift work must be tailored to the type of shift. For a night worker, circadian alignment can be achieved with bright light exposure during the shift and avoidance of bright light (with dark or amber sunglasses) toward the latter portion of the work period and during the morning commute home. If insomnia and/or excessive sleepiness are prominent complaints despite behavioral approaches and adequate opportunity for sleep, melatonin may be administered prior to the day sleep period to improve sleep, and alertness during work can be augmented by caffeine and wake-promoting agents.For jet lag, circadian adaptation is suggested only for travel greater than 48 h, with travel east more challenging than travel west. Although advancing sleep and wake times and circadian timing for eastward travel with evening melatonin and morning bright light several days prior to departure can help avoid jet lag at the new destination, this approach may be impractical for many people, Therefore, strategies for treatment at the destination, such as avoidance of early morning light and exposure to late-morning and afternoon light alone or in conjunction with bedtime melatonin, can accelerate re-entrainment following eastward travel. For westward travel, a circadian delay can be achieved after arrival with afternoon and early-evening light with bedtime melatonin.Good sleep hygiene practices, together with the application of circadian principles, can improve sleep quality, alertness, performance, and safety in shift workers and jet travelers. However, definitive multicenter randomized controlled clinical trials are still needed, using traditional efficacy outcomes such as sleep and performance as well as novel biomarkers of health.

Circadian rhythm sleep disorders

This article begins with a review of the major central nervous system functional systems that allow for optimal alertness during the waking day, and the rapid initiation and good maintenance of sleep at night. Subsequent sections discuss each of the 6 primary circadian rhythm sleep disorders. Attention is paid to known or suspected pathophysiology, diagnostic criteria and assessment methodology, and treatment options. The article concludes with a discussion of challenges that must be met to improve the recognition and treatment of these quite impactful sleep disorders.

Wrist actigraphy

To record sleep, actigraph devices are worn on the wrist and record movements that can be used to estimate sleep parameters with specialized algorithms in computer software programs. With the recent establishment of a Current Procedural Terminology code for wrist actigraphy, this technology is being used increasingly in clinical settings as actigraphy has the advantage of providing objective information on sleep habits in the patient's natural sleep environment. Actigraphy has been well validated for the estimation of nighttime sleep parameters across age groups, but the validity of the estimation of sleep-onset latency and daytime sleeping is limited. Clinical guidelines and research suggest that wrist actigraphy is particularly useful in the documentation of sleep patterns prior to a multiple sleep latency test, in the evaluation of circadian rhythm sleep disorders, to evaluate treatment outcomes, and as an adjunct to home monitoring of sleep-disordered breathing. Actigraphy has also been well studied in the evaluation of sleep in the context of depression and dementia. Although actigraphy should not be viewed as a substitute for clinical interviews, sleep diaries, or overnight polysomnography when indicated, it can provide useful information about sleep in the natural sleep environment and/or when extended monitoring is clinically indicated.

Jet lag and psychotic disorders

Jet lag syndrome appears after multiple time zone transitions as bodily rhythms shift out of phase with the local environment. The possible psychiatric complications of jet lag have been underinvestigated. In the present review, the symptoms of jet lag in the general population, the chronobiological aspects of psychosis, as well as a possible correlation between jet lag and psychosis are discussed. The conclusions are that jet lag, through disruption of biological rhythm and probably sleep deprivation, may yield an exacerbation of existing psychotic conditions. The evidence concerning the appearance of de novo psychosis triggered by jet lag is inconsistent and far from convincing.

International travel and the elite athlete

International travel is a frequent occurrence in the life of the elite athlete; such travel can pose challenges to the sport medicine practitioner. Travel is also the reality of many recreational level or sub-elite athletes as opportunities for international competition and training proliferate. An appreciation of the range of responsibilities associated with the preparation for and the strategies to facilitate such travel is essential for any physician charged with the care of athletes and teams. An appreciation of (1) the medical and public health challenges associated with competition in a particular setting; (2) the requirements for vaccination and immunization; (3) the strategies for the management of jet lag and climatic or environmental extremes; (4) the range of supplies and equipment necessary for travel to certain locales; (5) the need to ensure the availability of ample familiar and nutritious foods; (6) the potential need for specialty care in strange settings; (7) the management of common travel-associated illness; and (8) the challenges associated with the evacuation of an injured athlete are fundamental to the successful management of international travel involving athletes and teams. The adoption of a methodical approach to pre-trip planning can ensure an enhanced travel experience, illness-free training and competition, and facilitate optimal performance.

Human phase response curves to three days of daily melatonin: 0.5 mg versus 3.0 mg

CONTEXT

Phase response curves (PRCs) to melatonin exist, but none compare different doses of melatonin using the same protocol.

OBJECTIVE

The aim was to generate a PRC to 0.5 mg of oral melatonin and compare it to our previously published 3.0 mg PRC generated using the same protocol.

DESIGN AND SETTING

The study included two 5-d sessions in the laboratory, each preceded by 7-9 d of fixed sleep times. Each session started and ended with a phase assessment to measure the dim light melatonin onset (DLMO). In between were 3 d in an ultradian dim light (<150 lux)/dark cycle (light:dark, 2.5:1.5).

PARTICIPANTS

Healthy adults (16 men, 18 women) between the ages of 18 and 42 yr participated in the study.

INTERVENTIONS

During the ultradian days of the laboratory sessions, each participant took one pill per day at the same clock time (0.5 mg melatonin or placebo, double blind, counterbalanced).

MAIN OUTCOME MEASURE

Phase shifts to melatonin were derived by subtracting the phase shift to placebo. A PRC with time of pill administration relative to baseline DLMO and a PRC relative to midpoint of home sleep were generated.

RESULTS

Maximum advances occurred when 0.5 mg melatonin was taken in the afternoon, 2-4 h before the DLMO, or 9-11 h before sleep midpoint. The time for maximum phase delays was not as distinct, but a fitted curve peaked soon after wake time.

CONCLUSIONS

The optimal administration time for advances and delays is later for the lower dose of melatonin. When each dose of melatonin is given at its optimal time, both yield similarly sized advances and delays.

Associations between jet lag and cortisol diurnal rhythms after domestic travel

OBJECTIVE

Millions of adults in the United States travel abruptly across time zones each year. Nevertheless, the impact of traveling over relatively short distances (across 3 or fewer time zones) on diurnal patterning of typical physiological response patterns has yet to be studied in a large, epidemiological sample.

DESIGN

The current research focuses on 764 middle-aged men comparing variations in diurnal cortisol regulation based on number of time zones traveled eastward or westward the day before.

MAIN OUTCOME MEASURE

Participants provided samples of salivary cortisol at waking, 30-min postwaking, 10 a.m., 3 p.m., and bedtime.

RESULTS

Eastward travel was associated with a steeper salivary cortisol awakening response (p < .01) and lower peak (PEAK) levels of salivary cortisol the next morning (p < .05). Westward travel was associated with lower peak levels of cortisol the next morning (p < .05). Effect sizes for these differences ranged from Cohen's d = .29 to .47. Differences were not present for 2 days in their home environment.

CONCLUSIONS

The results provide evidence that traveling across time zones is associated with diurnal cortisol regulation and should be studied further to understand the subsequent impacts on health and well-being in large national samples.

Melatonin treatment for eastward and westward travel preparation

INTRODUCTION

Melatonin is recommended for hastening adaptation to phase shift, but there is little information on appropriate formulations.

MATERIALS AND METHODS

We evaluated the efficacy of three melatonin formulations for circadian phase advance and delay: (a) 3 mg regular release (RR), (b) 3 mg sustained release (SR), and (c) 3 mg surge-sustained release (SSR; consisting of 1 mg RR and 2 mg SR). Circadian phase was assessed by salivary melatonin dim light melatonin onset (DLMO) or offset (MelOff) using thresholds of (1) 1.0 pg/ml and (2) mean baseline + 2 standard deviations (BL + 2SD). Subjects spent from Tuesday evenings until Thursday in the laboratory. Melatonin (or placebo) was administered at 1600 hours (phase advance) Wednesday, with DLMO assessment on Tuesday and Thursday and at 0600 hours (phase delay) Wednesday, with DLMO assessment Tuesday, Wednesday, and MelOff Thursday morning. Phase advances using the 1.0 pg/ml DLMO were as follows: placebo, 0.73 h; RR, 1.23 h (p < 0.003); SR, 1.44 h (p < 0.0002); SSR, 1.16 h (p < 0.012), with no difference between formulations.

RESULTS AND DISCUSSION

Similar but smaller phase advances were found with BL + 2SD. Using MelOff, posttreatment phase position for the RR formulation was delayed compared to placebo by 1.12 h (p < 0.012), 1.0 pg/ml, and 0.75 h (p < 0.036), BL+2SD. Phase shifts for the SR and SSR conditions could not be determined due to persistent high melatonin levels during sampling times. Similar phase advances were induced by all formulations, and slow clearance of slow release preparations impeded the determination of phase delays.

CONCLUSION

Appropriately timed 0.5 mg melatonin doses may avoid these problems.