Overcoming Jet Lag: Alternative Models - Seminar, April 27, 2000

Mark R. Rosekind, PhD, Alertness Solutions

DR. DIMBERG: Thank you, David.

I would suggest that we proceed with the presentations and take the questions at the end, as we have done before.

If you are ready, Mark. You have already been introduced. I will let you take over the microphone.

DR. ROSEKIND: Let me just take fifteen minutes to talk about five strategies. Hold on to your seats, buckle up. Typically in a full presentation, we cover about 15 different strategies that are available to deal with jet lag, some focused on the sleep part, some focused on the circadian adjustment part, some focused on how do you stay awake in a situation where everything is fighting against you.

What I am going to do is cover, as I said, mostly recent strategies, but I wanted to start with this, and that is a lot of people, once they acknowledge jet lag and fatigue as an issue, they are looking for that magic bullet. Tell me there is a simple pill, strategy, whatever it is that is going to fix my jet lag.

So, one of the things I put up here is what we call the snake oil file, and these are some of my favorite snake oil collection here.

Up here on the upper left, this is 47 herbs and minerals from the Southwest, sit on this cushion and it cures your jet lag, $59.00 from the Sharper Image Catalogue.

What is really interesting is Dr. Dimberg and I were talking about how light is one of the most critical cues for the clock to know what time it is, and we know that it is a pathway to the [?] to the SCN. I never figured out what the pathway would be from this part of the anatomy to the SCN.

This is a [?] invisible shield; it cures jet lag blues, but really great, it also cures depression, migraines, all kinds of things. This is not a message service but rather a massage service in [?]

This one I added specifically for David and Mike from BA, but there is actually a booklet you can buy called "Twirling and Jet Lag". That is exactly what you think it is. When you travel west, you twirl in one direction; when you travel east, you twirl in another direction, ending up in what I call dead on the bed.

[LAUGHTER]

DR. ROSEKIND: Now, I always put these up because it is easy to make claims about strategies—I am going to give you a collection of things that have been demonstrated in studies, but also things that are kind of concepts, if you will, or that people have a lot of experience with, which may not have a scientific basis.

So, let me just go through a few of these. Here are two pilots in the cockpit, constantly diligent for any systems malfunctions. The captain scans the overhead panel, as the co-pilot checks the window heat system with his forehead; at 3:00 in the morning, pilots just cannot be too careful.

Since I know I am talking to a bunch of frequent travelers, I won't tell you the stories of having one, two, three pilots asleep at a time, but I have some great stories. If you ask later, I will be happy to tell you.

The reason I put this up here is this was the basis actually for a NASA study we did, wiring pilots up and giving them a nap in the cockpit, one at a time, so one person naps, two people flew the airplane. As you see, what we did is we literally wired them up.

So, we have EEG, reaction time test, et cetera. And I mention that because this was not a self-report study and I am going to spare you of all the details.

What we found is giving a forty-minute nap to sort of two groups—one got a forty-minute nap; the other control was not allowed a forty-minute nap—and what we found is the group that got the nap had a 34 percent improvement in performance. Basically, what you see is they maintain their performance compared to the no-nap group that reduced their performance, and we measured physiological alertness, those micro sleeps. This is what I was talking about in the other room.

Now you actually get to see them. And we measured micro sleeps that were five seconds or longer. How we come up with five seconds? Because there is no real definition; you can measure them down to half a second.

Well, we felt in an airplane going a few hundred miles above the ground cover, five seconds is a long time. And even though I said this, it is four o'clock in the afternoon, this is how dangerous I am willing to live. Close your eyes, count to five. Okay. Some of you can open your eyes; the rest of you can finish your nap.

The point is five seconds in an airplane that is going [?]; And I mention the data. Here they are. The number of micro sleeps in the last 90 minutes. This is an hour before descent and landing. This is literally ten minutes. So, the use of 134 micro sleeps; 22 of those occurred here, and the nap group had 34 micro sleeps, none during descent and landing.

And I always point out, there were no accidents, no incidents. So, there is no problem here. But who would you rather fly with, okay?

I always bring this one up because it doesn't matter how professionally well trained you are, physiologically when your brain is ready to shut you down—and you have all experienced this in cars driving, right—you would never get in the car thinking you would fall asleep at the wheel, but that shows the physiological strength of that signal.

So, we know that performance went up 34 percent, physiologically 100 percent in alertness. But if you want to use the strategy, here are the guidelines.

How long should a nap be? Up to forty-five minutes. Why forty-five? That helps you avoid that deep sleep we talked about. Right? Because if you go for about an hour, hour-and-a-half, you are going to end up right in the middle of that first deep sleep of the night.

So, when I say up to forty-five minutes—some people say it has got to be exactly twenty; forget that stuff; be practical. If you are really, really tired and you have only got five or ten minutes, take the ten minutes.

Salvador Dali supposedly used to nap by sitting in a chair with a spoon held over a tin plate. He would fall asleep, drop the spoon, it hit the plate, and he said he was fully refreshed when he woke up. That is a pretty short nap, right?

But any sleep is better than trying to struggle through it. If you are going to take a longer one, you want to make it two hours. What does that do? It gets you through that deep sleep? cycle we talked about. So, you want to go all the way through.

If you want to allow yourself about fifteen minutes, the sleep inertia we talked about, waking up groggy, it usually takes about ten or fifteen minutes to wake up and again just get physically []awake?, put water on the face, increase the light, et cetera, the cautions of the sleep inertia which I have already described.

The other thing is you don't want a long nap close to a planned sleep]. One of the mistakes people make is they come into?; they take that afternoon nap for a couple of hours and then think they are going to go to bed local time. It is not going to work.

But if you think about it, if you are truly dragging through the afternoon and you can't make to that local bedtime, take a twenty-minute or a forty-minute nap just to help you get through the evening so that you are not in [?] but not so much that it will interfere with the subsequent sleep period.

Hour after hour, cup after cup, the two men match their caffeine limits in a traditional contest of the Old West. They are ready for bed, right? Look at those guys.

This is what we call strategic caffeine use. And there are really just two numbers you have got to know about. One is it takes about fifteen to thirty minutes for caffeine to take an effect and actually wake you up and it lasts for three to four hours. This is why we call it strategic, and what you want to do is plan the use of caffeine before a vulnerable period. That is why we talked about what about right now, 3:00 to 5:00?

What is really important about knowing the time limit? is if you waited till 3:00 thinking you are going to be awake, forget it. Right? You have to start about 2:00 or 2:30 to start drinking it. But the other side of this is if you are on a duty period, and you drink that caffeine throughout your entire duty, whether you are in the ER or whatever it is, then you go home and go to bed, you are not falling asleep right away either. Right? Because the caffeine is still operating. So, keep those numbers in mind.

The other thing I would like to point out is that caffeine comes in different doses depending on the form that you like it. This slide gives you a sense. I'm not going through all of this. Here are the coffees and teas on the left, soft drinks on the right. Just to point out things like even decaf has caffeine in it. If you like it dripped versus brewed, it can affect dramatically the amount of caffeine.

And even the cola drinks, look at that, there is about a 10 milligrams difference between Pepsi and the cola drinks, whether it is coke or diet coke.

So, the form that you take can affect it, meaning it would take you a few of these to hit one of those. Right? We are all keeping Starbucks in mind. But besides the liquid form, in fact, in my office we prefer the sweet dark chocolate if you are going to have to get it, but caffeine is also obviously available in foods as well.

And abstain if you are sensitive. I know somebody, a woman, she has chocolate cake at dinnertime. She is not falling asleep at 11:00. That is how sensitive she is to caffeine. So, use it positively but also think about how it can give a negative effect impeding your sleep.

Let me talk a little bit about diet. People have heard about the jet lag diet. Yes? You have to really push feasting, fasting, push carbohydrates, proteins, very complicated. What is interesting is this is a great example of ? there is a book that is out; said it was used by, you know, Fortune 500 executives.

There are actually two studies that have been done at Cornell now for evaluating the jet lag diet. One of them found that the jet lag diet had the exact same effect as placebo on sleep. The other study found that placebo was better, that the jet lag diet actually disturbs sleep more than placebo. Okay?

So, when you take the scientific study, well, okay, can you do something about diet? You bet. The question came up in the other room; I will just cover it here. And I am sparing you all the other stuff, but there are not a lot of great studies showing that proteins, carbohydrates are going to make a huge difference in the adjustment part. You are hearing us talk about light and Melatonin, diet is not on that list. Does that mean you should ignore it? Absolutely not.

Here is what you should think about. Where is your time zone? What time zone is your stomach on? I am working for the sleep debt. I appreciate that, but I am working way under my number of hours I need.

All that means is think about where you are locally compared to home time. So, if you are about to enter a big dinner with people but it is breakfast for you, think about eating lighter or, conversely[?]. So, think about where your stomach is, eat the appropriate size based on the time zone; think about good nutritional practices, the alcohol. And nobody has really talked about the dehydration issue, but altitude can do that to you to some extent and do think about pushing liquids appropriately mostly to where you are comfortable, not every hour.

And I had to put this in; it is diet related, but there is so much talk about Melatonin, et cetera. I wanted to put this in. This is primarily an example of how people can claim all kinds of stuff, even do studies. So, when you look at the practical application, sometimes it is not going to work.

So, I just want to mention this one. tryptophan is actually an amino acid, and it is a building block for serotonin. Right? Serotonin actually provokes sleep. So, for years people thought tryptophan, if you get it at your health food store, you can use it as a natural sleeping pill.

Now what is really interesting is they have actually done laboratory studies on this, testing about one to five grams. And it ends up at five grams, tryptophan can give you good sleep effects, get to sleep, stay asleep, et cetera, almost equal to?]; five grams and it will go to work for you.

And what is interesting—many of you know this—but tryptophan is in cheese, milk, turkey, et cetera. So, this is probably where our myth about a warm glass of milk at bed or at Thanksgiving, you know, that big turkey portion?; microphone in and out].

Well, in my office, we actually decided to go and look how much would you actually have to eat of these things to get five grams of tryptophan because lab studies show five grams work. Well, yes, that would be about two-and-a-half gallons of milk --

[LAUGHTER]

DR. ROSEKIND: —half that Thanksgiving turkey, 55 slices of cheese or 110 containers of yogurt.

And again, I think, you know, there is a real scientific validity to the tryptophan and that might work, but when you think about that warm glass of milk, forget it. Right? If you tried the two-and-a-half gallons, you would be up all night going to the bathroom.

The last couple of things I am just going to cover quickly. One is there is stuff in the driving literature recently about when we are tired, roll the window down, put the music up, you know, talk to yourself, et cetera, put the radio on. It ends up that Jim Horton [ph] in the U.K. just did a great study showing that all of those actually do work for a short amount of time.

And I mention this because some of the research that came out said those things don't work. I point out they do work but they only work for ten or fifteen minutes. So, if you know you need a quick burst for something, think about changing your environment, put the lights on, be in an interaction with somebody, even driving or whatever. They are not as effective as caffeine or a nap, but there are things that can have transient, very short-term effects to help you kind of get a quick boost of alertness.

This is one I started to put in here that we are starting to talk about. It is what we call show me the data; that if somebody hands you something and says here is what will fix your jet lag, my immediate retort is show me the data.

And so, we made a list actually of the things, that if you are evaluating a strategy that somebody gives you, these are things that you should ask. Is there a known physiological mechanism? Well, with light and Melatonin, we know there is. It has an effect on [?]. How those 47 herbs and minerals get from tush up to [], you don't know. Okay?

So, right away you have to wonder whatever people are actually trying to sell you, is there a known physiological mechanism?

Is there any data on the side effects, positive effects, et cetera? Not any scientific data. There is one on the market that I won't mention that is from New Zealand, called "No Jet Lag". But if you get on their web site, it says they studied it all over the place, and maybe it is just being a scientist, but if it is not in some peer review journal or at some scientific validity to what they have done, you have to be concerned about the claims.

When you think about it, practical, easy, convenient to use. Another great example is we have totally avoided to the moment anyway of really explaining how do you apply light [?]. It is actually fairly easy and complex.

In about thirty seconds, I could tell you where to apply light, where to push your clock. Using it in the real way in a practical way is much more challenging, especially if you are [?] could use it, going someplace, staying for a while, coming home. But if you are going one place, going another place, it can get very complicated.

So, one thing you always have to ask: Is it practical, easy, convenient to use, cost-effective—I shouldn't have to explain that one—but also from where you folks sit what are the benefits versus the risks of a lot of these strategies?

Whether it is Melatonin or something else, is something that you are recommending actually worthwhile and can you identify again both the benefits and the risks?

The last two slides—first, this one. One of the things we really push is taking a comprehensive approach to this. There is not one thing that is going to work for you all the time. It will change with age, where you fly, the requirements of your trip [?]. So, one of the things you want to think about is how to use multiple strategies. And the other is how you tailor those to your needs.

Some people, they don't want to nap; they cannot nap; they don't like napping. Some people, for whatever reason, won't drink caffeine. So, you have to figure out what works for you. I can sit here and say a forty-five minute nap and someone will say three minutes work for me. Bless you; you know, find out what works for you and what fits your needs.

Another thing to think about is how to evolve your approach. I have talked about aging as one of the primary things. But as your travel demands change, and as your physiology changes, all of these things mean you shouldn't stagnate but evolve your approach. That includes using new strategies when they come out, when there really is a good sleeping pill or Melatonin, or whatever. You should really be prepared.

The last thing I have to put up. If you don't do something, you will pay for this. Every once in a while somebody comes forward and actually announces that. And so, this is a very high visible individual who actually acknowledged that every major error he made in his life was made when he was tired. And this is actually President Clinton, April 1993.

[LAUGHTER]

DR. ROSEKIND: I would point out this is the only strategy you do not use in the legal defense and it brings new meaning to fatigue counter measure, if you pick it up.

Thank you.

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