Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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No naps
- Frank Shann (7 February 2003)
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Re: No naps
- Steve Hayes (8 February 2003)
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Children and melatonin
- Paul Montgomery (8 February 2003)
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alternative remedies
- Alison E Payne (8 February 2003)
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Is it dehydration?
- Andrew Hoyle (10 February 2003)
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Who profits from clinical studies, has to pay
- Regina B. Stroebele (10 February 2003)
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Jetlag
- Theodore F. Redman (10 February 2003)
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Apples on aeroplanes
- Christine J Reid (13 February 2003)
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Two perspectives on jet lag
- Chris Chung (14 February 2003)
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Just A Bit More
- Ned Hoke (15 February 2003)
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The prevention and treatment of jet lag
- David C McLoughlin, SG17 5JH (24 February 2003)
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Idle speculation from the idle.....
- Martin Harvey (2 March 2003)
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Re: Idle speculation from the idle.....
- Steve Hayes (3 March 2003)
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Intra-glial glycogen stores and jet lag
- Richard G Fiddian-Green (4 March 2003)
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Frank Shann, Director of Intensive Care Royal Children's Hospital, Melbourne 3052, Australia
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Dr Herxheimer and Dr Waterhouse provide helpful advice about the use of melatonin. However, I do not agree with their advice to "take a brief nap" on arrival at the destination after a long flight. My extensive experience of travel between Australia and Europe suggests that it is much better NOT to take a nap. After travel across time zones, it is important to stay awake until bedtime at the destination. This can be very difficult to do, but going for a walk or engaging in other physical activity helps. The traveller who does take a nap soon after arrival finds it harder to get to sleep at the correct bedtime for the destination, and is more likely to wake in the middle of the night and find it difficult or impossible to get back to sleep. Taking a nap during the day delays the transition to the new time zone. Competing interests: None declared |
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Steve Hayes, manager Outside In (Cambridge) Ltd, 31 Scotland Rd Estate, Dry Drayton, Cambridge, CB3 8AT
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Lewy and colleagues have a number of papers concerning TIMING of melatonin administration, which are certainly more sophisticated than "bedtime". Lewy now has data suggesting that smaller doses correctly timed are more effective (though this was for a blind person) An alternative for jetlag is using Light correctly timed, a calculation for any jouney can be made at www.bodyclock.com Commercial interest very clearly confessed to, we make and sell the lights. Competing interests: www.bodyclock.com we make and sell lights for circadian adjustment |
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Paul Montgomery, Researcher Oxford University Dept of Psychiatry, Park Hospital, Old Road, Headington, Oxford. OX3 7LQ
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It is good to see a paper looking at Chronobiology in the BMJ. I agree with the authors that considerably more work on this area is needed. I would have liked it more if it has encompassed more of the population, notably children. The evidence of the effectiveness of Melatonin in children is less clear for any (sleep) disorder including Jet Lag. Where there is evidence, questions about dosage remain unanswered although in general it seems the case that supraphysiological doses have been given in many trials. There is some limited evidence from animal studies that it may be linked to reproductive function. It may be the case that this issue may apply to adults also. As far as I am aware this is not yet properly established. Competing interests: None declared |
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Alison E Payne, GP, Paraparaumu, New Zealand
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In NZ we have a homoeopathic remedy called "No Jet Lag" which is a combination of verious homoeopathic preparaitons supposedly to assist in adjusting one's body clock. Our local travel medicine specialists reckon it is a waste of time (but then most Doctors seem to think homoeopathy is a waste of time!) However my view is that it MIGHT help - and even if it's just a placebo effect - who cares? Anything that helps me get over jet lag, or even makes me think I'm getting over jet lag quicker, is not harmful and only costs $NZ10 in the local pharmacy is worth it.... Competing interests: ex pat Brit of seven years, travel between UK & NZ regularly |
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Andrew Hoyle, GP Registrar Harpenden, Hertfordshire
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Sir, I am disappointed to see the misuse of the word "dehydration" in a medical journal. Dehydration, as The Telegraph crossword once observed (abcdefgpqrstuvwxyz (9)) is the loss of water. It does not refer to the loss of water and solute which ought best be described as fluid or volume depletion. Dehydration indeed occurs e.g diabetes insipidus. It is unusual, however.
Competing interests:
None declared |
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Regina B. Stroebele, Specialist in additionl.postgraduation D-81677 Munich/Bavaria
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I agree with the author that additional studies are a reasonable way to evaluate the risks and benefits of a MSH-routine for transcontinental flights in people who fly. But who will be interested in paying depends on who profits. A person travelling privately will already believe in the benefit of MSH when he buys the product. A professional will be interested not to suffer from jet-lag because his employer expects him to do qualified work, or he himself must travel because of his work. So, he will have to pay, because MSH-intake keeps him from making mistakes or losing his job.... Assuming he believes this! The MSH producers sell a lot of pills, also in Europe, without any additional proof of the efficacy and the lack of severe adverse effects. So, why should they pay for further studies, as long as MSH is not prohibited? And the State? Can it be interested in the destruction of a company with good results concerning profits and number of employed persons?? In addition, the state is made up of taxpayers. Most taxpayers in any country of the world will not fly so frequently and so they will not be willing to pay for a tax-financed study. Only possibility: Sponsoring of an FDA (or similar institution somewhere else) investigation by the producer of a competing product... Competing interests: None declared |
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Theodore F. Redman, retired nil;retired
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In connection with article on jet lag (B.M.J. February 8th.) may I offer a simple piece of advice which always works for me; I have never had jet lag when I follow it. Set you watch to the time applicable at your destination as soon as the aicraft takes off and act on it - for food and sleep and especially for watchiing videos. In the article it advises one to "eat moderately at the times that correspond to one`s usual `mealtimes ". I would modify this to read "at the times that correspond to one`s usual mealtimes based on the time applicable at one`s destination". _________________________________ T.F.Redman, T.D.,F.R.C.S.(Ed),F.R.C.O.G. Leeds, LS8 2PX. Competing interests: None declared |
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Christine J Reid, Medical librarian Seacroft Hospital LS14 6UH
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Herxheimer & Waterhouse (The prevention and treatment of jet lag, 326, pp 296-7) advocate eating apples on long-haul flights. A couple of days after reading this article my husband flew to Melbourne, eating a couple of apples en route. Apparently importing fruit into Australia is not allowed, and a sniffer dog picked up the smell of the apples in my husband's briefcase. He had to explain that the apple was now inside him. Competing interests: None declared |
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Chris Chung, SHO A+E Formerly Royal Hospital for Sick Children, Glasgow
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The smartest tactic I've seen on a long haul flight was when I flew from London to Hong Kong non stop. A twenty something girl in the window seat in the row in front of me brought a extra large pillow as her hand luggage. After the plane settled at cruising altitude, she changed into pyjamas, curled up against the pillow which rested against the window and slept virtually the whole journey. Presumably she stayed up late whilst still in London. On arrival, she freshened up, landed in Hong Kong at lunchtime and had put the rest of the bleary eyed cabin to shame! Digressing, doing nightshift in A+E is akin to jet lag. Except when you reset your body clock, you don't have the pleasure of waking up in holiday resort. Competing interests: None declared |
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Ned Hoke, Private Ecological Healthcare Western USA
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I am in wholehearted agreement with this editorial with one mild additional consideration. My traveling clients sleep disruption needs sensible organizatiion as written here. So very often now this is co-mingled with sudden onset respiratory distress for which I routinely offer basic oriental herbals or echinacea to be taken in advance. This additional step has made long haul air travel quite tolerable for a good number of my clients. Competing interests: None declared |
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David C McLoughlin, SpR in Occupational medicine Centre of Aviation Medicine, RAF Henlow, SG17 5JH
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EDITOR - Herxheimer and Waterhouse describe the prevention and treatment of jet lag with an emphasis on drug measures.1 Indeed, the beneficial effect of melatonin has been known for some time. In 1989, the BMJ published a study, which concluded that melatonin may alleviate jet lag and tiredness after long haul flights.2 In contrast non-drug measures were only briefly described and the practical advice given overlaps with good general travel advice.3 As non-drug measures are the established methods they deserved further elaboration in this editorial. Herxheimer and Waterhouse claim that dry cabin air contributes to dehydration. Air entering an aircraft during flight has a relative humidity of less than 1% but the humidity in the cabin is increased markedly by exhaled air and moisture from the galley and toilets. Nevertheless nasal dryness is common, but studies have found little fluid depletion.4 Any dehydration during flight is more likely to be due to decreased fluid intake or the consumption of alcohol and caffeine containing drinks. Finally, Herxheimer and Waterhouse’s call for toxicological studies and licensing of melatonin are to be applauded. However, they believe public funds should be used for these studies as the government and armed forces would benefit from the use of melatonin. This benefit is limited as any minor neuro-psychiatric side effect would prohibit its use in aircrew and military doctrine already emphasizes local acclimatisation, as is currently happening in the Gulf region. I believe the main beneficiaries would be business travellers. Many already buy melatonin as a dietary supplement overseas. Perhaps British industry could take up Herxheimer and Waterhouse’s challenge? David C McLoughlin Competing interests: None declared 1. Herxheimer A, Waterhouse J. BMJ 2003;326:296-7. 2. Petrie K, Conaglen JV, Thompson L, Chamberlain K. BMJ 1989;298:705-7. 3. Htttp://www.britishairways.com/travel/health/public. 4. Macnamara WD, Nicholson AN. Study of the effect of the cabin environment on insensible water loss. Aerospace Med 1969;40:657-9. Competing interests: None declared |
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Martin Harvey, Family Physician Calgary, AB Canada T2s2s7
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I have on several occasions when reading about the merits of Melatonin (or other homeopathic remedies)wondered if there has been any research or informed speculation as to the safety of these products. Whenever I see a patient taking some form of pituitary extract, I tell them I wonder about the safety of this practice in light of our emerging knowledge of slow viral diseases and prions. I have yet to place researching this topic higher on my to do list. I wonder if anyone else is aware of any such work? Martin Harvey Competing interests: None declared |
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Steve Hayes, commercial Cambridge CB3 8AT UK
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melatonin can be fully synthetic, and I believe it can still be obtained made from bovine brain material (!) Competing interests: as previous post, we make and sell lights for circadian applications |
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Richard G Fiddian-Green, None None
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I have travelled extensively in the past and am very familar with jet lag. I developed a system that allowed me to do this without being compromised by jet lag. I believe the method might have worked because it gave my glial cells the opportunity to replenish their glycogen stores and/or by allowing my synaptic vesicles to replenish their neurotransmitter pools(1). My system when, for example, I travelled from Boston to London was to take one Halcion tablet as soon as the plane got off the ground at Logan International airport, put eye shades on and go to sleep. I chose the window seat to do this for it allowed me to rest my head and not be disturbed by people climbing over me. I would often sleep until we came into land at Heathrow. I had a shower as soon as I could and entered a full day's activities but made sure that I stayed awake as late as I could that night before retiring. The killer, I had found, was going to sleep too early, waking at 2am and not being able to get back to sleep or alternatively having a nap during the day and not being tired enough to fall asleep when I went to bed. I took another Halcion that night and if I stayed in the UK another the second night. By that time my biological clock had adjusted and I had no further need for Halcion. I have proposed that synaptic vesicles may behave like thylacoids responsible for photosynthesis in chloroplasts and that sleep is a biological necessity analogous to the dark phase of photosynthesis during which starch is synthesised (1). In terms of this hypothesis, by making sure I got a good night's sleep and avoiding the killer of waking at 2am, I gave my glial cells and neurons ample time to replenish their glycogen and/or neurotransmitter pools. 1. Treating dementia with light and near infrared waves Richard G Fiddian-Green bmj.com/cgi/eletters/325/7376/1312#29607, 12 Feb 2003 Competing interests: None declared |
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