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Jet lag

Cathy A Goldstein, MD
Section Editor
Ruth Benca, MD, PhD
Deputy Editor
April F Eichler, MD, MPH


Air travel allows individuals to traverse time zones faster than the internal clock, or circadian rhythm, can adjust. This results in desynchrony between the external light-dark cycle and the endogenous circadian rhythm. Jet lag ensues, which manifests as impaired alertness during the desired wake time and/or difficulty sleeping during the allotted time for sleep at the destination.

This topic reviews the underlying pathophysiology, clinical features, evaluation, and treatment of jet lag. Other circadian rhythm sleep-wake disorders are reviewed separately. (See "Overview of circadian sleep-wake rhythm disorders".)


The prevalence of jet lag is unknown [1]. The impact of age and gender on the likelihood of developing jet lag has not been clearly defined [2], although older adults may be less likely to experience symptoms of jet lag [3,4].


Circadian rhythms are the near 24-hour processes that allow an organism to react in an appropriate manner to environmental light-dark changes caused by the earth's rotation every 24 hours. The most obvious circadian rhythm is the sleep-wake cycle, which typically aligns to the light-dark cycle.

The circadian rhythm of sleep and wake is paralleled by the secretion of melatonin and oscillation of core body temperature (CBT):


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Literature review current through: Sep 2016. | This topic last updated: Jul 13, 2016.
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  1. American Academy of Sleep Medicine. International Classificatin of Sleep Disorders, 3rd ed, American Academy of Sleep Medicine, Darien, IL 2014.
  2. Sack RL, Auckley D, Auger RR, et al. Circadian rhythm sleep disorders: part I, basic principles, shift work and jet lag disorders. An American Academy of Sleep Medicine review. Sleep 2007; 30:1460.
  3. Tresguerres JA, Ariznavarreta C, Granados B, et al. Circadian urinary 6-sulphatoxymelatonin, cortisol excretion and locomotor activity in airline pilots during transmeridian flights. J Pineal Res 2001; 31:16.
  4. Waterhouse J, Edwards B, Nevill A, et al. Identifying some determinants of "jet lag" and its symptoms: a study of athletes and other travellers. Br J Sports Med 2002; 36:54.
  5. Borbély AA. A two process model of sleep regulation. Hum Neurobiol 1982; 1:195.
  6. Burgess HJ, Eastman CI. Human tau in an ultradian light-dark cycle. J Biol Rhythms 2008; 23:374.
  7. Czeisler CA, Duffy JF, Shanahan TL, et al. Stability, precision, and near-24-hour period of the human circadian pacemaker. Science 1999; 284:2177.
  8. Dunlap JC, Loros JL, DeCoursey PJ. Chronobiology: Biological Timekeeping, Sinauer Associates Publishers, Sunderland, MA 2004.
  9. St Hilaire MA, Gooley JJ, Khalsa SB, et al. Human phase response curve to a 1 h pulse of bright white light. J Physiol 2012; 590:3035.
  10. Duffy JF, Wright KP Jr. Entrainment of the human circadian system by light. J Biol Rhythms 2005; 20:326.
  11. Lewy AJ, Bauer VK, Ahmed S, et al. The human phase response curve (PRC) to melatonin is about 12 hours out of phase with the PRC to light. Chronobiol Int 1998; 15:71.
  12. Lewy AJ, Ahmed S, Jackson JM, Sack RL. Melatonin shifts human circadian rhythms according to a phase-response curve. Chronobiol Int 1992; 9:380.
  13. Lewy A. Clinical implications of the melatonin phase response curve. J Clin Endocrinol Metab 2010; 95:3158.
  14. Wyatt JK, Dijk DJ, Ritz-de Cecco A, et al. Sleep-facilitating effect of exogenous melatonin in healthy young men and women is circadian-phase dependent. Sleep 2006; 29:609.
  15. Takahashi M, Nakata A, Arito H. Disturbed sleep-wake patterns during and after short-term international travel among academics attending conferences. Int Arch Occup Environ Health 2002; 75:435.
  16. Waterhouse J, Reilly T, Atkinson G, Edwards B. Jet lag: trends and coping strategies. Lancet 2007; 369:1117.
  17. Rajaratnam SM, Polymeropoulos MH, Fisher DM, et al. Melatonin agonist tasimelteon (VEC-162) for transient insomnia after sleep-time shift: two randomised controlled multicentre trials. Lancet 2009; 373:482.
  18. Scheen AJ, Van Cauter E. The roles of time of day and sleep quality in modulating glucose regulation: clinical implications. Horm Res 1998; 49:191.
  19. Katz G, Knobler HY, Laibel Z, et al. Time zone change and major psychiatric morbidity: the results of a 6-year study in Jerusalem. Compr Psychiatry 2002; 43:37.
  20. Forbes-Robertson S, Dudley E, Vadgama P, et al. Circadian disruption and remedial interventions: effects and interventions for jet lag for athletic peak performance. Sports Med 2012; 42:185.
  21. Coutinho JF, Gonçalves OF, Maia L, et al. Differential activation of the default mode network in jet lagged individuals. Chronobiol Int 2015; 32:143.
  22. Fuller CW, Taylor AE, Raftery M. Does long-distance air travel associated with the Sevens World Series increase players' risk of injury? Br J Sports Med 2015; 49:458.
  23. Aschoff J, Hoffmann K, Pohl H, Wever R. Re-entrainment of circadian rhythms after phase-shifts of the Zeitgeber. Chronobiologia 1975; 2:23.
  24. Cho K, Ennaceur A, Cole JC, Suh CK. Chronic jet lag produces cognitive deficits. J Neurosci 2000; 20:RC66.
  25. Grajewski B, Whelan EA, Lawson CC, et al. Miscarriage among flight attendants. Epidemiology 2015; 26:192.
  26. Iglesias R, Terrés A, Chavarria A. Disorders of the menstrual cycle in airline stewardesses. Aviat Space Environ Med 1980; 51:518.
  27. Lauria L, Ballard TJ, Caldora M, et al. Reproductive disorders and pregnancy outcomes among female flight attendants. Aviat Space Environ Med 2006; 77:533.
  28. Radowicka M, Pietrzak B, Wielgoś M. Assessment of the occurrence of menstrual disorders in female flight attendants - preliminary report and literature review. Neuro Endocrinol Lett 2013; 34:809.
  29. Pukkala E, Helminen M, Haldorsen T, et al. Cancer incidence among Nordic airline cabin crew. Int J Cancer 2012; 131:2886.
  30. Schubauer-Berigan MK, Anderson JL, Hein MJ, et al. Breast cancer incidence in a cohort of U.S. flight attendants. Am J Ind Med 2015; 58:252.
  31. Thaiss CA, Zeevi D, Levy M, et al. Transkingdom control of microbiota diurnal oscillations promotes metabolic homeostasis. Cell 2014; 159:514.
  32. Lowden A, Akerstedt T. Retaining home-base sleep hours to prevent jet lag in connection with a westward flight across nine time zones. Chronobiol Int 1998; 15:365.
  33. Morgenthaler TI, Lee-Chiong T, Alessi C, et al. Practice parameters for the clinical evaluation and treatment of circadian rhythm sleep disorders. An American Academy of Sleep Medicine report. Sleep 2007; 30:1445.
  34. Auger RR, Burgess HJ, Emens JS, et al. Clinical Practice Guideline for the Treatment of Intrinsic Circadian Rhythm Sleep-Wake Disorders: Advanced Sleep-Wake Phase Disorder (ASWPD), Delayed Sleep-Wake Phase Disorder (DSWPD), Non-24-Hour Sleep-Wake Rhythm Disorder (N24SWD), and Irregular Sleep-Wake Rhythm Disorder (ISWRD). An Update for 2015: An American Academy of Sleep Medicine Clinical Practice Guideline. J Clin Sleep Med 2015; 11:1199.
  35. Revell VL, Burgess HJ, Gazda CJ, et al. Advancing human circadian rhythms with afternoon melatonin and morning intermittent bright light. J Clin Endocrinol Metab 2006; 91:54.
  36. Paul MA, Gray GW, Lieberman HR, et al. Phase advance with separate and combined melatonin and light treatment. Psychopharmacology (Berl) 2011; 214:515.
  37. Eastman CI. High-intensity light for circadian adaptation to a 12-h shift of the sleep schedule. Am J Physiol 1992; 263:R428.
  38. Eastman CI, Burgess HJ. How To Travel the World Without Jet lag. Sleep Med Clin 2009; 4:241.
  39. www.jetlagrooster.com (Accessed on April 04, 2016).
  40. entrain.math.lsa.umich.edu (Accessed on April 04, 2016).
  41. Dean DA 2nd, Forger DB, Klerman EB. Taking the lag out of jet lag through model-based schedule design. PLoS Comput Biol 2009; 5:e1000418.
  42. Serkh K, Forger DB. Optimal schedules of light exposure for rapidly correcting circadian misalignment. PLoS Comput Biol 2014; 10:e1003523.
  43. Burgess HJ, Crowley SJ, Gazda CJ, et al. Preflight adjustment to eastward travel: 3 days of advancing sleep with and without morning bright light. J Biol Rhythms 2003; 18:318.
  44. Eastman CI, Gazda CJ, Burgess HJ, et al. Advancing circadian rhythms before eastward flight: a strategy to prevent or reduce jet lag. Sleep 2005; 28:33.
  45. Wever RA. Use of light to treat jet lag: differential effects of normal and bright artificial light on human circadian rhythms. Ann N Y Acad Sci 1985; 453:282.
  46. Honma K, Honma S, Sasaki M, Endo T. Bright lights accelerate the re-entrainment of circadian clock to 8-hour phase-advance shift of sleep-wake schedule: 1) Circadian rhythms in rectal temperature and plasma melatonin level. Jpn J Psychiatry Neurol 1991; 45:153.
  47. Boivin DB, James FO. Phase-dependent effect of room light exposure in a 5-h advance of the sleep-wake cycle: implications for jet lag. J Biol Rhythms 2002; 17:266.
  48. Sasaki M, Kurosaki Y, Onda M, et al. Effects of bright light on circadian rhythmicity and sleep after transmeridian travel. Sleep Res 1989; 18:442.
  49. Cole R, Kipke DF. Amelioration of jet lag by bright light treatment: Effects on sleep consolidation. Sleep Res 1989; 18:411.
  50. Thompson A, Batterham AM, Jones H, et al. The practicality and effectiveness of supplementary bright light for reducing jet-lag in elite female athletes. Int J Sports Med 2013; 34:582.
  51. Suhner A, Schlagenhauf P, Johnson R, et al. Comparative study to determine the optimal melatonin dosage form for the alleviation of jet lag. Chronobiol Int 1998; 15:655.
  52. Roth T, Stubbs C, Walsh JK. Ramelteon (TAK-375), a selective MT1/MT2-receptor agonist, reduces latency to persistent sleep in a model of transient insomnia related to a novel sleep environment. Sleep 2005; 28:303.
  53. Kato K, Hirai K, Nishiyama K, et al. Neurochemical properties of ramelteon (TAK-375), a selective MT1/MT2 receptor agonist. Neuropharmacology 2005; 48:301.
  54. Richardson GS, Zee PC, Wang-Weigand S, et al. Circadian phase-shifting effects of repeated ramelteon administration in healthy adults. J Clin Sleep Med 2008; 4:456.
  55. Zee PC, Wang-Weigand S, Wright KP Jr, et al. Effects of ramelteon on insomnia symptoms induced by rapid, eastward travel. Sleep Med 2010; 11:525.
  56. Lavie P. Effects of midazolam on sleep disturbances associated with westward and eastward flights: evidence for directional effects. Psychopharmacology (Berl) 1990; 101:250.
  57. Donaldson E, Kennaway DJ. Effects of temazepam on sleep, performance, and rhythmic 6-sulphatoxymelatonin and cortisol excretion after transmeridian travel. Aviat Space Environ Med 1991; 62:654.
  58. Reilly T, Atkinson G, Budgett R. Effect of low-dose temazepam on physiological variables and performance tests following a westerly flight across five time zones. Int J Sports Med 2001; 22:166.
  59. Jamieson AO, Zammit GK, Rosenberg RS, et al. Zolpidem reduces the sleep disturbance of jet lag. Sleep Med 2001; 2:423.
  60. Daurat A, Benoit O, Buguet A. Effects of zopiclone on the rest/activity rhythm after a westward flight across five time zones. Psychopharmacology (Berl) 2000; 149:241.
  61. Suhner A, Schlagenhauf P, Höfer I, et al. Effectiveness and tolerability of melatonin and zolpidem for the alleviation of jet lag. Aviat Space Environ Med 2001; 72:638.
  62. Paul MA, Gray G, Sardana TM, Pigeau RA. Melatonin and zopiclone as facilitators of early circadian sleep in operational air transport crews. Aviat Space Environ Med 2004; 75:439.
  63. Beaumont M, Batéjat D, Piérard C, et al. Caffeine or melatonin effects on sleep and sleepiness after rapid eastward transmeridian travel. J Appl Physiol (1985) 2004; 96:50.
  64. Piérard C, Beaumont M, Enslen M, et al. Resynchronization of hormonal rhythms after an eastbound flight in humans: effects of slow-release caffeine and melatonin. Eur J Appl Physiol 2001; 85:144.
  65. Rosenberg RP, Bogan RK, Tiller JM, et al. A phase 3, double-blind, randomized, placebo-controlled study of armodafinil for excessive sleepiness associated with jet lag disorder. Mayo Clin Proc 2010; 85:630.
  66. Petit E, Mougin F, Bourdin H, et al. A 20-min nap in athletes changes subsequent sleep architecture but does not alter physical performances after normal sleep or 5-h phase-advance conditions. Eur J Appl Physiol 2014; 114:305.
  67. Boulos Z, Macchi MM, Stürchler MP, et al. Light visor treatment for jet lag after westward travel across six time zones. Aviat Space Environ Med 2002; 73:953.
  68. Gundel A, Spencer MB. A circadian oscillator model based on empirical data. J Biol Rhythms 1999; 14:516.
  69. Takahashi T, Sasaki M, Itoh H, et al. Re-entrainment of the circadian rhythms of plasma melatonin in an 11-h eastward bound flight. Psychiatry Clin Neurosci 2001; 55:275.
  70. Fowler PM, Duffield R, Morrow I, et al. Effects of sleep hygiene and artificial bright light interventions on recovery from simulated international air travel. Eur J Appl Physiol 2015; 115:541.
  71. Petrie K, Conaglen JV, Thompson L, Chamberlain K. Effect of melatonin on jet lag after long haul flights. BMJ 1989; 298:705.
  72. Petrie K, Dawson AG, Thompson L, Brook R. A double-blind trial of melatonin as a treatment for jet lag in international cabin crew. Biol Psychiatry 1993; 33:526.