What is jet lag?

Jet lag, also called desynchronosis and flight fatigue, is a temporary disorder that causes fatigue, insomnia, and other symptoms as a result of air travel across time zones. It is considered a circadian rhythm sleep disorder, which is a disruption of the internal body clock.

What are other symptoms and signs of jet lag?

Besides fatigue and insomnia, a jet lag sufferer may experience a number of physical and emotional symptoms including anxiety, constipation, diarrhea,confusion, dehydration, headache, irritability, nausea, sweating, coordination problems, dizziness, and even memory loss. Some individuals report additional symptoms, such as heartbeat irregularities and increased susceptibility to illness. Children can also suffer the same jet lag symptoms as adults.

What is a time zone?

A time zone is a geographical region which has the same time everywhere within it. The world has 24 time zones, one for each hour in the day. Each zone runs from north to south in strips that are approximately 1,000 miles (1,600 kilometers) wide. (The actual width of each zone varies to accommodate political and geographical boundaries.) As the earth rotates, dawn occurs at a set hour in one time zone, then an hour later in the time zone immediately to the west and so on through the 24-hour cycle. Thus, in the U.S., when it is 6 a.m. in the eastern time zone, it is 5 a.m. in the central zone, 4 a.m. in the mountain zone, and 3 a.m. in the Pacific zone.

Why does jet lag occur?

The cause of jet lag is the inability of the body of a traveler to immediately adjust to the time in a different zone. Thus, when a New Yorker arrives in Paris at midnight Paris time, his or her body continues to operate on New York time. As the body struggles to cope with the new schedule, temporary insomnia, fatigue, irritability, and an impaired ability to concentrate may set in. The changed bathroom schedule may cause constipation or diarrhea, and the brain may become confused and disoriented as it attempts to juggle schedules.

How does the body keep time?

Our bodies have a sort of internal biological clock that follows a 24-hour cycle, called a circadian rhythm. A tiny part of the brain called the hypothalamus acts like an alarm clock to activate various body functions such as hunger, thirst, and sleep. It also regulates body temperature, blood pressure, and the level of hormones and glucose in the bloodstream. To help the body tell the time of day, fibers in the optic nerve of the eye transmit perceptions of light and darkness to a timekeeping center within the hypothalamus. Thus, when the eye of an air traveler perceives dawn or dusk many hours earlier or later than usual, the hypothalamus may trigger activities that the rest of the body is not ready for, and jet lag occurs.

What is the role of melatonin in jet lag?

Melatonin is a hormone that plays a key role in body rhythms and jet lag. After the sun sets, the eyes perceive darkness and alert the hypothalamus to begin releasing melatonin, which promotes sleep. Conversely, when the eyes perceive sunlight, they tell the hypothalamus to withhold melatonin production. However, the hypothalamus cannot readjust its schedule instantly; it takes several days.

Does the direction of travel matter?

Comment on thisRead 1 CommentShare Your Story Yes. Travelers flying north or south in the same time zone typically experience the fewest problems because the time of day always remains the same as in the place where the flight originated. These travelers may experience discomfort, but this usually results from confinement in an airplane for a long time or from differences in climate, culture, and diet at the destination location. Time differences do not play a role. Travelers flying east, on the other hand, typically experience the most problems because they "lose" time. For example, on an international flight from Washington, D.C., to Mecca, Saudi Arabia, a traveler loses eight hours. Meals, sleep, bowel habits, and other daily routines are all pushed ahead eight hours. Travelers flying west "gain" time and usually have an easier time adjusting than eastward travelers. However, they too experience symptoms of jet lag after landing because they still must adjust to a different schedule.

Do the symptoms of jet lag vary in intensity?

Yes. People flying across only one or two time zones may be able to adjust without noticeable effects of the time change. Those flying across three or more time zones will likely develop noticeable symptoms of jet lag. Generally, the intensity of symptoms varies in relation to the number of time zones crossed and the direction of travel. People also vary in their susceptibility to jet lag symptoms and the severity of the symptoms.

How long does jet lag last?

Recovering from jet lag depends on the number of time zones crossed while traveling. In general, the body will adjust to the new time zone at the rate of one or two time zones per day. For example, if you crossed six time zones, the body will typically adjust to this time change in three to five days.

What are the best ways to cope with jet lag?

Comment on thisRead 1 CommentShare Your Story There are several home remedies that can help withprevention of jet lag and easier recovery from the symptoms. The following are 12 tips to help travelers to avoid or to minimize the effects of jet lag.

Tip 1: Stay in shape If you are in good physical condition, stay that way. In other words, long before you embark, continue to exercise, eat right, and get plenty of rest. Your physical stamina and conditioning will enable you to cope better after you land. If you are not physically fit, or have a poor diet, begin shaping up and eating right several weeks before your trip. Tip 2: Get medical advice If you have a medical condition that requires monitoring (such as diabetesor heart disease), consult your physician well in advance of your departure to plan a coping strategy that includes medication schedules and doctor's appointments, if necessary, in the destination time zone. Tip 3: Change your schedule If your stay in the destination time zone will last more than a few days, begin adjusting your body to the new time zone before you leave. For example, if you are traveling from the U.S. to Europe for a one-month vacation, set your daily routine back an hour or more three to four weeks before departure. Then, set it back another hour the following week and the week after that. Easing into the new schedule gradually in familiar surroundings will save your body the shock of adjusting all at once. If you are traveling east, try going to sleep earlier and getting up and out into the early morning sun. If traveling west, try to get at least an hour's worth of sunlight as soon as possible after reaching your destination. Tip 4: Avoid alcohol Do not drink alcoholic beverages the day before your flight, during your flight, or the day after your flight. These beverages can cause dehydration, disrupt sleeping schedules, and trigger nausea and general discomfort. Tip 5: Avoid caffeine Likewise, do not drink caffeinated beverages before, during, or just after the flight. Caffeine can also cause dehydration and disrupt sleeping schedules. What's more, caffeine can jangle your nerves and intensify any travel anxiety you may already be feeling. Tip 6: Drink water Drink plenty of water, especially during the flight, to counteract the effects of the dry atmosphere inside the plane. Take your own water aboard the airplane if allowed. Tip 7: Move around on the plane While seated during your flight, exercise your legs from time to time. Move them up and down and back and forth. Bend your knees. Stand up and sit down. Every hour or two, get up and walk around. Do not take sleeping pills, and do not nap for more than an hour at a time.

These measures have a twofold purpose. First, they reduce your risk of developing a blood clot in the legs. Research shows that long periods of sitting can slow blood movement in and to the legs, thereby increasing the risk of a clot. The seat is partly to blame. It presses against the veins in the leg, restricting blood flow. Inactivity also plays a role. It decelerates the movement of blood through veins. If a clot forms, it sometimes breaks loose and travels to the lungs (known as pulmonary embolism), lodges in an artery, and inhibits blood flow. The victim may experience pain and breathing problems and cough up blood. If the clot is large, the victim could die. Second, remaining active, even in a small way, revitalizes and refreshes your body, wards off stiffness, and promotes mental and physical acuity which can ease the symptoms of jet lag. Tip 8: Break up your trip On long flights traveling across eight, 10, or even 12 time zones, break up your trip, if feasible, with a stay in a city about halfway to your destination. For example, if you are traveling from New York to Bombay, India, schedule a stopover of a few days in Dublin or Paris. (At noon in New York, it is 5 p.m. in Dublin, 6 p.m. in Paris, and 10:30 p.m. in Bombay.) Tip 9: Wear comfortable shoes and clothes On a long trip, how you feel is more important than how you look. Wear comfortable clothes and shoes. Avoid items that pinch, restrict, or chafe. When selecting your trip outfit, keep in mind the climate in your destination time zone. Dress for your destination. Tip 10: Check your accommodations Upon arrival, if you are staying at a hotel, check to see that beds and bathroom facilities are satisfactory and that cooling and heating systems are in good working order. If the room is unsuitable, ask for another. Tip 11: Adapt to the local schedule The sooner you adapt to the local schedule, the quicker your body will adjust. Therefore, if you arrive at noon local time (but 6 a.m. your time), eat lunch, not breakfast. During the day, expose your body to sunlight by taking walks or sitting in outdoor cafs. The sunlight will cue your hypothalamus to reduce the production of sleep-inducing melatonin during the day, thereby initiating the process of resetting your internal clock. When traveling with children, try to get them on the local schedule as well. When traveling east and you will lose time, try to keep the child awake until the local bedtime. If traveling west when you will gain time, wake your child up at the local time. Tip 12: Use sleeping medications wisely -- or not at all Try to establish sleeping patterns without resorting to pills. However, if you have difficulty sleeping on the first two or three nights, it's OK to take a mild sedative if your physician has prescribed one. But wean yourself off the sedative as soon as possible. Otherwise, it could become habit-forming.

There are also some homeopathic remedies that may be used. A product called No Jet Lag contains homeopathic remedies leopard's bane (Arnicamontana), daisy (Bellis perennis), wild chamomile (Matricaria chamomilla), ipecac (Cephalelis ipecacuanha), and club moss (Lycopodium). Valerian root is an herb that can be used as treatment for insomnia. Do not take valerian with alcohol. It is important to consult your physician before taking these or any other homeopathic or herbal remedy. Sleep medications are not recommended for children.

Should I take melatonin?

Comment on thisShare Your Story Another option is synthetic melatonin, which is classified in the U.S. as a dietary supplement. A study in the British Medical Journal in 1989 reported that taking synthetic melatonin tablets can help travelers restore normal sleeping patterns. In that study, 20 volunteers traveling back and forth between New Zealand and England took daily doses of either 5 mg of melatonin or a placebo (a blank, or sugar pill) before, during, and after their flights. Those taking melatonin returned to their normal sleep patterns in 2.85 days on average compared with 4.15 days for those taking a placebo. However, scientists in the U.S. and many other countries are not yet convinced that enough evidence exists to prove the efficacy of over-the-counter (OTC) melatonin tablets. These scientists also point out the following:
1. No information has been compiled on the long-term effects of taking melatonin.2. No watchdog measures are in place to assure that all OTC melatonin products meet minimum standards.

In 2005, MIT released the results of a meta-analysis of 17 peer-reviewed studies using melatonin. It showed that melatonin was effective in helping people fall asleep at doses of 0.3 mg. Larger doses of melatonin seem to be less effective after only a few days' use. For the purpose of treating jet lag, it is suggested that a dose between 0.3 mg and 5 mg of melatonin be taken on the first day you travel at the time you will want to go to sleep at your destination. This may be continued at bedtime for a few days once you are at your destination. Melatonin seems to be most effective when crossing five or more time zones, or traveling east. Be aware that higher doses of melatonin can cause sleepiness, lethargy, confusion, and decreased mental sharpness. Operating motor vehicles or heavy machinery should be avoided after taking your daily dose of melatonin. Consult your health-care provider if you plan on taking melatonin.

REFERENCES: Breus, Michael J. "How Long Does Jet Lag Last?" WebMD.com. Dec. 14, 2010. <http://answers.webmd.com/answers/1195390/How-long-does-jet-lag-last>. Herxheimer, A., and K.J. Petrie. "Melatonin for the Prevention and Treatment of Jet Lag." Cochrane Database Syst. Rev. 2 (2002). <http://www.ncbi.nlm.nih.gov/pubmed/12076414>. "Melatonin and Sleep." National Sleep Foundation. <http://www.sleepfoundation.org/article/sleep-topics/melatonin-and-sleep>. "Sleep and Circadian Rhythm Disorders." WebMD.com. Mar. 3, 2010. <http://www.webmd.com/sleep-disorders/guide/circadian-rhythm-disorders-cause>. United States. National Institute of General Medical Sciences. "Circadian Rhythms Fact Sheet." July 2008. <http://www.nigms.nih.gov/Education/Factsheet_CircadianRhythms.htm>.
http://www.medicinenet.com/jet_lag/article.htm

Jet lag is a feeling of tiredness and confusion after a long aircraft journey. It's the result of your body finding it difficult to adjust to a new time zone. Jet lag can disturb your sleep pattern and make you feel drowsy and lethargic (lacking in energy). The more time zones you cross during a long-haul flight, the more severe jet lag can become. Read more about the symptoms of jet lag.

What causes jet lag? The world is divided into 24 different time zones. Your body's natural 24-hour clock (circadian rhythm) is disrupted after crossing time zones. Your body clock controls your sleeping and waking pattern. It also affects your:
hunger digestion bowel habits urine production body temperature

blood pressure

Your body clock is set to your local time so that you feel hungry in the morning and sleepy in the evening. However, if you travel across time zones, your body clock can take a while to adjust to a new daily routine. Read more about the causes of jet lag.

Treating jet lag

Jet lag can be a problem if you frequently fly long distances. However, it doesn't usually cause any serious or long-term health problems. Most people find their symptoms pass after a few days without need for treatment. The advice below will help minimise the effects of jet lag. When you arrive at your destination:
Establish a new routine. Eat and sleep at the correct times for your new time zone, not at the time you usually eat and sleep at home. Avoid napping as soon as you arrive. Even if you are tired after a long flight, stay active until the correct time to sleep; this will help your body adjust more quickly. Spend time outdoors. Natural light will help your body adjust to a new routine.

If you take medication at specific times of the day, such as oral contraceptives or insulin, speak to your GP or pharmacist before travelling for advice. Read more about treating jet lag.

Preventing jet lag

It is not possible to prevent jet lag but there are things you can do to reduce its effects. Make sure you are well hydrated before flying, and drink plenty of fluid (but not alcohol) during the flight. Try to rest during the flight by taking short naps. Read more about preventing jet lag.

Symptoms of jet lag

The symptoms of jet lag can vary from person to person. The severity of your symptoms will usually depend on the distance travelled and the number of time zones crossed. Most people only have jet lag symptoms after crossing at least three time zones. Some people may find they get mild symptoms after shorter journeys.

Sleep disturbance
A disturbed sleep pattern is one of the most common symptoms of jet lag. You may find it difficult to sleep at the correct times. For example, you may be awake at night and sleep during the day.

Other symptoms
As well as disturbed sleep, other symptoms can include: indigestion constipation diarrhoea nausea loss of appetite difficulty concentrating feeling disoriented anxiety irritability memory problems clumsiness lack of energy light-headedness confusion headaches sweating muscle soreness irregular periods in women who travel frequently generally feeling unwell

Symptoms will usually last for no more than a day or two, depending on how quickly your body is able to adjust to the new time zone.

Causes of jet lag

Jet lag occurs when the body's normal daily routine is disrupted after crossing several different time zones. Symptoms such as sleep disruption and tiredness are the result of your body finding it difficult to adjust to the time zone of your new location.

Circadian rhythm
Circadian rhythm is your body's natural 24-hour routine, which is controlled by "biological clocks" in your body. Jet lag occurs when your body's circadian rhythm is disrupted. The biological clocks are found throughout your body and are made up of groups of cells that interact with each other. The cells are controlled by a "master clock" in your brain that keeps all the body clocks synchronised. Your body is used to a regular routine of light and darkness at certain times of the day. However, when you travel to a new time zone this routine is disrupted. Air travel makes it possible to cross several different time zones in just a few hours. Due to travelling so quickly, your body has to catch up and re-establish its circadian rhythm. It takes time for your body to adjust to new times of light, darkness and eating. It may also have to adjust to differences in temperature.

Oxygen levels
Oxygen levels in an aeroplane cabin are also thought to play a role in jet lag. The air pressure found in an aeroplane cabin is lower than normal, which means the amount of oxygen in your blood is reduced. A reduced amount of oxygen can affect your physical and mental abilities. For example, it can make you feel lethargic (lacking in energy) and dehydrated (when the normal water content in your body is reduced). If you have a health condition, such as heart disease, lung disease or anaemia (where red blood cells are unable to carry enough oxygen), you may be more severely affected by the reduction in oxygen inside the cabin.

East and west

Symptoms of jet lag are usually more severe when travelling east. This is because your body finds it easier to adapt to a longer day (you "gain time" travelling west) than a shorter one (you "lose time" travelling east). Your body is able to adapt better when you travel west because you are extending your day, rather than shortening it when you travel east. Therefore, it's usually easier to delay sleep for a few hours than trying to force sleep when you're not ready to.

Increased risk
Other things that increase jet lag or increase the severity of your symptoms include: dehydration (not drinking enough fluids) lack of sleep drinking alcohol stress being over the age of 60

Treating jet lag

There are several things you can do to minimise the effects of jet lag . When you arrive at your destination: Establish a new routine and try to get used to it as soon as possible . Eat and sleep at the correct times for your new time zone, not when you usually eat and sleep at home. Avoid napping as soon as you arrive at your destination . Even if you are tired after a long flight, try to stay active until the correct time to sleep; this will help your body adjust more quickly. Spend time outdoors. Natural light will help your body adjust to a new routine. If you take medication at specific times of the day, such as oral contraceptives or insulin, consult your GP or pharmacist before travelling. They will advise you when to take your medication after you arrive at your destination.

Melatonin
Melatonin is a hormone that your body releases in the evening. It lets your brain know it is time for your body to sleep. Your body clock is controlled by natural daylight and by the melatonin released in your body. Melatonin is produced when it gets dark to prepare your body for sleep. Your body stops producing the hormone when it gets light to help you wake up. Some jet lag remedies contain melatonin to help you sleep at night when your body is finding it difficult to adjust to the new time zone. However, there is currently not enough evidence to say whether melatonin supplements are effective. Some people find them helpful but they are not currently licensed to treat the prevention of jet lag in the UK. There is also insufficient evidence regarding the possible side effects of melatonin for people taking the blood-thinning medicinewarfarin, or those with epilepsy (a condition that causes repeated fits or seizures). Speak to your GP if you are thinking about taking a jet lag remedy that contains melatonin. They will be able to advise whether it is suitable for you.

Sleeping tablets
Some people find taking sleeping tablets can help relieve jet lag. However, they are not usually recommended because they can be very addictive if used for more than a few days. Sleeping tablets can also cause side effects such as: runny nose headaches diarrhoea

Preventing jet lag

Jet lag can't be prevented but you can take steps to reduce its effects.

Before travelling
Before you travel: Change your sleep routine a few days before your departure. If you are travelling east, go to bed an hour earlier than your usual time; if you are travelling west, go to bed an hour later. Try to adapt your sleeping routine with your destination in mind. Get enough sleep before you travel. Flying when you are tired can make jet lag worse. Keep calm and relaxed. Airports can often be stressful places; keep calm to avoid getting stressed, as stress can make jet lag worse. Check in online. This can help reduce stress and will enable you to relax as soon as you arrive at the airport.

During the flight

During the flight: Drink plenty of fluids. Ensure you are well hydrated before, during and after your flight. Rest during the flight. Take short naps. Limit your caffeine consumption. Avoid drinking too many drinks that contain caffeine, such as coffee, tea and cola, and avoid drinking them within a few hours of planned sleep. Avoid alcohol. Eat light meals and avoid drinking alcohol because it can make the symptoms of jet lag worse. Keep active. When flying long distances, take regular walks around the cabin and stretch your arms and legs while you are sitting down; this will also help reduce your risk of developing a potentially serious condition called deep vein thrombosis (DVT). Change your watch to match the time of your new destination. This will help you to adjust to your new time zone more quickly.

Try to get some sleep if it is night time when you arrive at your destination. You may find using ear plugs and an eye mask is useful.

Short trips
It may be better to stay on "home time" if you are only taking a short trip (less than three or four days). If possible, arrange activities and sleep to coincide with the time at home. This will reduce the chances of your body clock being disrupted.

http://www.nhs.uk/Conditions/Jet-lag/Pages/Introduction.aspx

Jet lag
Jet lag is characterized most commonly by day-time fatigue, insomnia, lengthening of reaction time, and degradation of memory and concentration. Further symptoms may occur, such as increased irritability, listlessness, nausea, headache, inordinate hunger or complete loss of appetite, gastrointestinal and urinary functions at mismatched times, degradation of physical and mental functions, and a generalized feeling of exhaustion. Synonyms for jet lag include time shift, flight syndrome, and circadian desynchronization. The symptom complex is generated by transmeridian flight over several time zones (3 time zones), providing a swift relocation from one geographical place to another. This causes a temporary discrepancy between the accustomed individual circadian cycle, which has been shaped by long-term living at the same geographical place, and that which is required at the new place. Temporary health effects and performance limitations are not linked to disease; all symptoms disappear after a few days. Re-establishment of the normal function and efficiency of the traveler requires about 24 hours for every two hours of time shift. Individual hormonal parameters normalize themselves much more slowly. Eastward flights are more performance-reducing than westward flights, as the internal tendency of humans is to lengthen rather than shorten the circadian period. A flight toward the west requires approximately 20% less recovery time than a flight to the east. Eastward flights over more than two time zones are less problematic for the so-called evening types than for the morning types. The temporary desynchronization of the bodily functions (CNS, hormonal and vegetative) occurs as a physiological reaction in 1520% of all passengers crossing more than two time zones. The most important countermeasure for overcoming jet lag is the immediate adjustment to the temporal conditions at the destination. Alcohol and sleeping medications should be avoided. Relaxation techniques, like autogenous training and breathing techniques are preferable. Protein-rich foods for sleep delay and carbohydrates for the promotion of sleep are recommended. Conversion of sleep-wake cycle prior to travel has had only marginal success. To mitigate the effect of jet-lag, the following are recommended:

 Activity before westward flights: go to sleep at increasingly later times a few days prior to travel Activity at departure: change the clock to destination time and adapt to mealtime and sleep cycles of the destination. Arrange a one-day layover at half the travel distance during flights to the east (e.g. intermediate stop in Dubai during flight from London to Bangkok) After the flight: fight off sleeplessness (take melatonin (5300 mg/day); use relaxation techniques such as autogenous training Remain awake after morning arrivals, soon after landing take a long walk in the open so that melatonin production is inhibited. Countermeasures during flight: 1. eat only light food with little salt, fat and sugar; 2. during flights to the west, eat particularly protein-rich food in order to extend wakefulness; 3. drink a lot of fluids, above all mineral waters and fruit juices, but no alcohol 4. do not smoke; 5. take several 20-minute naps, but do not take sleeping pills; 6. walk around in the cabin when possible and compensate for lack of movement by performing in-seat exercises (flex and extend the ankles in particular); 7. after a long transmeridian flight, try not to fall asleep before local bedtime.

Performance Degradation by Alcohol and Drug Abuse

Frequency of abuse It is estimated that 2.53 million people in Germany (3.5% of the population) are alcohol dependent; of these approximately 800 000 are admitted to mental hospitals. It is further estimated that 14% of men and 5% of women are in a danger zone, close to becoming dependent on alcohol, approximately 800 000 are dependent on prescription drugs, and approximately 100000 are dependent on illicit drugs. Within the professional pilot populations, 57% alcohol dependence is suspected, and in the USA 710% of pilots are assumed to have problems with alcohol, corresponding to a total number of 75 000 pilots (1991). Accident statistics in Germany indicate that 6.5% of aviation accidents have alcohol as a possible cause (19731983); in airline aviation, however, so far not one accident has been so caused. In approximately 2% of all fatal aviation accidents, drug use and illness (e.g. cardiac infarct) in the pilot play a role. The United States Air Force determined that alcohol was involved in 15% of fatal accidents, and other drugs were involved in 7% of cases (19731984). The drinking behavior of pilots indicates that 15% use alcohol regularly for stress management, i.e. to dismantle tensions. Effects of alcohol Because of the impairment of human performance, alcohol should be avoided 24 hours before flight. Simulator studies with experienced pilots have demonstrated a decrease in concentration,

vigilance, decision-making abilities, fine-motor coordination, depth perception and coordinated stereoptic activities, beginning at a blood alcohol concentration of 0.25 parts per thousand, and becoming manifest around 0.4 parts per thousand. Furthermore, an increased willingness to take risks and to make unsafe decisions occurs. In routine flying operation, an upper limit of 0.4 parts per thousand is necessary; this corresponds to the blood alcohol limit prescribed in the USA. Nevertheless, the so-called hangover effect is important to keep in mind. Performance degradations can occur with a blood alcohol level of 0.0 parts per thousand, if earlier alcohol ingestion yielded a blood alcohol level of 1.0 part per million. Preventive measures are: 24 hours of sobriety, alcohol breath analysis before each flight, and testing of visual-motoric concentration ability in the cockpit. Fundamental aviation

'Economy class' DVT syndrome myth busted

Sitting in a window seat during a long flight can increase the risk of deep vein thrombosis, according to The Daily Telegraph. It has long been known that flying is associated with an increased risk of deep vein thrombosis (DVT), a type of serious blood clot in a major vein, but new US guidance has looked at a range of factors that could potentially raise the risk. Those of you thinking of booking your summer holiday might be interested to know that flying in cramped budget seats, while often annoying, presented no greater risk than flying in business class. And while pricey booze available during a flight can prove wallet-damaging, the guidelines say there was no firm evidence that drinking it could bring on DVT. However, sitting by a window during a long-haul flight was associated with a greater risk because of the limited opportunities for walking around. Peoples age, previous DVT and recent operations were among the other factors found to raise DVT risk. The evidence-based guidelines were produced by the American College of Chest Physicians to address the risk of both DVT after long-haul flights and the potentially fatal lung clots (pulmonary embolisms) that can follow. The guidelines also include recommendations about the best ways for travellers to reduce their risk of DVT. The guidelines seem to debunk the long-held assumption that a lack of legroom causes DVT. This muchdebated phenomenon is often referred to as economy-class syndrome.

What is economy-class syndrome?

It is long established that inactivity is associated with DVT, and so some people believe that the lack of legroom when flying in economy class can increase the risk of developing a blood clot. This has led to the theoretical phenomenon being dubbed economy-class syndrome. Some have also suggested that dehydration is more common during economy travel and may increase the risk of DVT. However, the existence of this so-called economy-class syndrome is controversial and has never been proven.

What is DVT?
Deep vein thrombosis or DVT is when blood clots form in a deep vein. A clot that develops in a vein is also known as venous thrombosis. DVT most commonly affects the leg veins or deep veins in the pelvis. It can cause pain and swelling in the leg but in some cases there may be no symptoms. DVT can lead to the potentially life-threatening condition known as a pulmonary embolism. This occurs when a clot breaks off into the bloodstream and travels to the chest, where it blocks one of the blood vessels in the lungs. Experiencing DVT and pulmonary embolism together is known as venous thromboembolism (VTE), which is a condition that can be life-threatening. Each year more than 25,000 people in England die from VTE contracted in hospital. This is approximately 25 times the number of people who die from MRSA. VTE occurs in hospitals as a result of patients lying sedentary in bed for extended periods following an operation. In recent years the NHS and Department of Health have run a major programme of measures to help reduce the rates of VTE developed in hospitals. For example, many patients are now given a VTE risk assessment when being booked into hospital.

Who is at risk of DVT?

In the UK each year about one person in every 1,000 is affected by DVT. Anyone can develop it but there are certain known risk factors that include: increasing age pregnancy previous venous thromboembolism family history of thrombosis medical conditions such as cancer and heart failure inactivity (for example after an operation or on a long-haul flight) being overweight or obese

Where has the advice come from?

The advice comes from new evidence-based guidelines produced by the American College of Chest Physicians (ACCP). The findings were published in the February issue of the medical journal CHEST. The guidelines are extensive, running over hundreds of pages. They detail both the risk factors for DVT and measures to diagnose and prevent DVT.

What do these guidelines tell us?

The evidence review that informed the guidelines looked at a range of risk factors for the development of DVT in long-distance travellers. These included the use of oral contraceptives, sitting in a window seat, advanced age, dehydration, alcohol intake, pregnancy and sitting in an economy seat compared to business class. The reviewers conclude that developing DVT or pulmonary embolism from a long-distance flight is generally unlikely, but that the following factors increased peoples risk: previous DVT or pulmonary embolism or known thrombophilic disorder cancer recent surgery or trauma immobility advanced age oestrogen use, including oral contraceptives pregnancy sitting in a window seat obesity

The finding relating to window seats was discussed further. The study authors suggest that long-distance travellers sitting in a window seat tend to have limited mobility, which is responsible for their increased risk of DVT. However, the review did not find any definitive evidence to support the theory that dehydration, alcohol intake or sitting in an economy seat (compared with sitting in business class) increases the risk of DVT or pulmonary embolism during a long-distance flight. On this basis, they conclude that travelling in economy class does not increase the risk of developing a blood clot, even during long-distance travel. However, they believe that remaining immobile for long periods of time does. Overall, the study authors say that symptomatic DVT/PE [pulmonary embolism] is rare in passengers who have returned from long flights, but that the association between air travel and DVT/PE is strongest for flights longer than 8-10 hours. Furthermore, most of the passengers who do end up developing a DVT/PE after long-distance travel have one or more risk factors.

What can be done to prevent DVT?

For travellers on flights longer than six hours who have an increased risk of DVT the new guidelines recommend: Frequent walking about during the flight. Calf muscle stretching. Sitting in an aisle seat if possible (as you are more likely to get up and move around during the flight). Wearing below-the-knee compression stockings that are graduated, meaning they apply greater pressure lower down the leg. They are designed to put pressure on the lower legs, feet and ankles to increase bloodflow, thereby making it harder for a clot to form. The guidelines do not recommend compression stockings for long-distance travellers who are not at increased risk of DVT. The guidelines advise against using blood-thinning aspirin or anticoagulant therapy to prevent DVT or pulmonary embolism for most people. They suggest that anti-clotting medications should be considered on an individual basis only for those at particularly high risk of DVT, as in some cases the risks may outweigh the benefits.

http://www.nhs.uk/news/2012/02February/Pages/economy-class-syndrome-dvt-myth.aspx

Economy class syndrome: The formation of blood clots in veins deep within the legs -- deep vein thrombosis -- occurring during (or just after) a long airplane flight, especially in economy class (tourist class) where there is the least space allotted per passenger and ones legs tend especially to be immobilized for lack of leg room. The economy class syndrome is directly related to immobility for long periods during which blood pools in the legs, raising the risk of clot formation. The tendency to immobility is often compounded by the fasten-seat belt sign, the presence of carts in the aisles, etc. Other risk factors contributing to the syndrome include lower oxygen pressure and dehydration. Changes in oxygen pressure in the cabin tend to decrease the oxygen level in the blood. The air in the cabin lacks the normal degree of humidity which contributes to dehydration. The serving of coffee, tea, and alcoholic beverages (all of which are diuretics) further causes passengers to become dehydrated. The economy class syndrome is not confined to that class on a plane. It is recommended that all persons traveling on air flights, irrespective of which class they are in, drink lots of water and move their legs by walkingwhenever possible and by periodically flexing and extending their ankles, knees, and hips to minimize the risk of economy class syndrome. Deep vein thrombosis is potentially serious and can even have fatal consequences.

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As air travel increases each year, Americans can expect to hear and see more news about the term economy class syndrome (ECS). This term is used to describe the leg symptoms experienced by frequent air travelers or air passengers on long trips, and has been associated with the serious leg condition called deep vein thrombosis (DVT). While there is a heightened concern about this condition among air passengers, many people are not aware that there are easy, effective and economical solutions that can reduce the symptoms of ECS and decrease the risk for DVT. Medical-grade gradient compression hosiery, such as Jobst Gradient Hosiery can help prevent the leg swelling and decreased blood circulation that may be contributors to DVT. Risk assassment Deep Vein Thrombosis (DVT) Risk Factors DVT can strike men and women who are in good health with relatively little warning. However, certain health conditions may increase a person's risk for DVT. o o o o o o o o o Obesity Pregnancy Chronic heart disease Use of hormone medications Malignancies/cancerous tumors History of blood clots Varicose veins Recent trauma or surgery Smoking

If you feel you are at risk for DVT, please consult your physician prior to travelling to discuss your health and medical history. Your physician can review treatment options available to help manage pre-existing conditions in an effort to minimize your risk for this serious medical condition. Tips for Reducing Your Risks for Economy Class Syndrome and Deep Vein Thrombosis (DVT) During Air Travel o o o o o o Stay hydrated. Avoid alcohol and beverages with caffeine. Get up and walk around the plane every hour. Wear loose-fitting, non-restrictive clothing. Flex and stretch your legs to improve blood flow when restricted to your seat. Ask your physician if you are predisposed to any risk factors for DVT. Wear gradient compression hosiery.

Facts About Economy Class Syndrome (ECS) and Deep Vein Thrombosis (DVT) "Economy Class Syndrome" (ECS) is the term associated with a serious condition called deep vein thrombosis (DVT). Crowded, cramped conditions and limited physical activity during extended air travel may increase the risks for DVT. ECS got its name from the inactivity associated with air travel, particularly in cramped coach seating.

During prolonged periods of inactivity, the effects of gravity make it difficult for the blood in the veins of the legs to return to the heart. Activity of the calf muscles is needed to contract and pump blood up the legs. Without this activity, blood can pool in the legs, causing swelling and discomfort and may develop into a blood clot in a deep vein deep vein thrombosis. When normal activity resumes, the blood clot can break off and form an embolism that can pass to the heart or lungs, obstruct the pulmonary arteries, and lead to death. Development of thrombi during extended air travel has been documented throughout the past 40 years. Air travelers, including Richard Nixon in 1972, have experienced the effects of these conditions after flying. Although DVT can strike individuals who are in good health with relatively little warning, there are people who are at greater risk for developing the condition. Obesity, pregnancy, chronic heart disease, use of hormone medications, malignancies, history of blood clots, varicose veins, and 1 recent trauma or surgery may increase a person's risk for DVT. Travelers should ask a physician if they are predisposed to any risk factors for DVT. DVT is not only associated with long flights. This condition may also be linked with activities or 1 occupations that involve long periods of passive sitting. To reduce the risk for DVT while traveling, physicians recommend wearing gradient compression hosiery to improve blood circulation in the legs in conjunction with foot/ankle exercises and walking. Jobst is the number one physician-recommended brand of gradient compression hosiery in the United States.

DVT 'hits all travel.' The Mirror, United Kingdom, March 14, 2001

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Gradient compression socks or stockings, such as Jobst Gradient Compression Hosiery, deliver pressure at the ankle that gradually decreases as it extends up the leg, helping to move blood back to the heart. This activity reduces blood pooling in the legs and helps prevent the symptoms associated with "Economy Class Syndrome" (ECS) and the risk for a more serious leg condition called deep vein thrombosis (DVT).

To help prevent ECS and DVT, air travelers should wear medicalgrade gradient compression hosiery, such as Jobst Gradient Compression Hosiery, which offers the most accurate fit based on ankle and calf circumferences. Proper fit guarantees delivery of the most precise and effective gradient compression profile to the legs. Jobst Gradient Compression Hosiery products are available at three ranges of gradient compression 15-20 mmHg, 20-30 mmHg, and 30-40 mmHg to provide therapeutic benefits for a wide range of venous and lymphatic disorders. Jobst Gradient Compression Hosiery is effective in the management of other venous disorders, from minor to severe conditions, including varicose veins, edema, and chronic venous insufficiency. Jobst Gradient Compression Hosiery is the number one physicianrecommended brand of gradient compression hosiery in the United States. Conrad Jobst pioneered the concept of gradient compression application to the legs and patented the first gradient compression

stocking in 1950.

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