Sleepless in Senegal? Melatonin May Help

While others debate whether the hormone melatonin can help us sleep, reverse aging and thwart disease, travel medicine experts have progressed to another argument: What’s the best dose to ward off jet lag?

Study after study has shown that melatonin helps minimize jet lag, which afflicts nearly all long-distance fliers and tends to get worse with age. But experts still don’t concur on exactly when travelers should take it . . . or how much.

They do agree that melatonin isn’t a cure-all, emphasizing that the best anti-jet-lag strategy combines melatonin with natural light therapy and prudent health habits to reset the body clock in a new time zone.

Nicknamed the Dracula of hormones because it is produced in darkness, melatonin is released by the tiny pineal gland deep within the brain and prepares the body for sleep by causing drowsiness. When light returns, production stops.

Melatonin supplements are selling briskly at health food stores and drugstores, as treatment for both insomnia and jet lag. But melatonin regimens for preventing jet lag can get complicated, due to variable factors such as the length of the trip and whether it is eastbound or westbound.

Among the simplest regimens suggested is to take melatonin before travel and to use “light therapy” at the destination, said Dr. Al Lewy, professor of psychiatry at Oregon Health Sciences University and a long-time melatonin researcher.

Lewy recommends using small doses of melatonin--only .5 milligrams--less than the 2.5 or 3 milligram over-the-counter tablets commonly sold at health food stores and drugstores.

Lewy’s regimen calls for eastbound travelers to begin melatonin a day or two before leaving the West Coast. Take a .5 milligram dose in the middle of the afternoon, he said. Westbound travelers should take that same small dose in the morning to reset the body clock to destination time.

Once at the destination, use light therapy to reset the body clock, Lewy suggests. “When traveling east, get outdoors in the morning as much as you can. When traveling west, get outdoors in the late part of the day [before the sun sets].” This advice applies only when six time zones or fewer are crossed.

If traveling through more than six time zones, however, the regimen changes.

“Get light in the middle of the day no matter which direction [travel is],” Lewy said. If traveling west, avoid light late in the day; if traveling east, avoid light early in the day.

Taking melatonin after arrival is also recommended by Lewy, but the regimen is so individual that he advises travelers to consult a doctor familiar with melatonin use to set up a schedule.

Other travel medicine experts propose slightly different regimens, although the same principle of using light as a stimulant and melatonin to encourage drowsiness prevails.

“If traveling east, take one [tablet] in the late afternoon for three days before departure,” advises Dr. Alan Spira, a Beverly Hills physician who specializes in travel medicine. “Then when you arrive, take [one tablet] at bedtime for four days.

“If traveling west, upon arrival take one at bedtime for four days,” said Spira, who also recommends light therapy. “Light and melatonin work in concert,” he said. Spira suggests taking doses of 2 to 8 milligrams of melatonin, but travelers are cautioned to consult their physician about the proper dosage.

“We’re not recommending people take it on their own,” Lewy said. “Talk to your doctor about what your upper limit is.” Doses that don’t bother one person can leave another feeling drowsy the next morning. Some people report a hang-over effect after taking 3 milligrams, Lewy said.

Melatonin isn’t recommended for children, teen-agers or pregnant women, according to Rick Livingstone, a field representative for Source Naturals, a melatonin manufacturer in Scotts Valley, Calif. And people with autoimmune disease (such as rheumatoid arthritis), leukemia, epilepsy and other conditions are advised to consult their doctor before use, as are people on certain medications.

In the near future, melatonin regimens are expected to become more standardized for jet-lag prevention, as research by Lewy and others progresses. But anti-jet-lag regimens will never be one-size-fits-all due to variations between individuals, as well as traveling situations. Some travelers are sensitive to a one-hour time zone difference; others don’t feel ill effects until three, four or more time zones are crossed.

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The Healthy Traveler appears the second and fourth week of every month.