Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ACUTE

short stay in the new time zone (≤2 days)

1st line – maintenance of home time zone daily routine

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ACUTE
|
short stay in the new time zone (≤2 days)
1st line – 

maintenance of home time zone daily routine

Patients should be encouraged to keep their time schedule in the new time zone as similar as possible to their home schedule to avoid rebound symptoms when they return.​[5][8]

Consider – melatonin

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ACUTE
|
short stay in the new time zone (≤2 days)
Consider – 

melatonin

Additional treatment recommended for SOME patients in selected patient group

Exogenous melatonin can be considered for patients with moderate to severe symptoms of jet lag.[5][8]​​[11][13][14][15][16]​​​ However, the dose and timing of administration needs to be determined.

Melatonin is widely available as a dietary supplement in various formulations. Therefore, the bioavailability of melatonin may vary depending on the purity of preparation.[11]

Primary options

melatonin: 2-5 mg orally (immediate-release) once daily at bedtime in new time zone for 3-4 days

Consider – sedative/hypnotic

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ACUTE
|
short stay in the new time zone (≤2 days)
Consider – 

sedative/hypnotic

Additional treatment recommended for SOME patients in selected patient group

The use of sedatives/hypnotics should be limited to treating acute insomnia of jet lag.[8][11]

The non-benzodiazepine hypnotic zolpidem given for 3 consecutive nights, starting with the first night's sleep at the new destination, has been shown to improve sleep in some travellers.[11][18] However, there is a risk of rebound insomnia after discontinuation of the sedatives/hypnotics.

Short-acting benzodiazepines can be used; however, their use with alcohol has the risk of causing amnesia during a flight. One study showed improved sleep quality following eastward travel with temazepam.[19]

Primary options

zolpidem: 5 mg orally (immediate-release) once daily at bedtime when required; 6.25 mg orally (extended-release) once daily at bedtime when required; higher doses may cause next-morning drowsiness and are not recommended, especially in women

OR

zopiclone: 3.75-7.5 mg orally once daily at bedtime

OR

temazepam: 10-20 mg orally once daily at bedtime

long stay in new time zone (>2 days)

1st line – phase-advance light exposure

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ACUTE
|
long stay in new time zone (>2 days)
|
eastward travel
1st line – 

phase-advance light exposure

Patients travelling eastward need to phase-advance. This can be achieved by avoiding light exposure during the evening and encouraging early morning light exposure before travel.[6] Wearing sunglasses during evening hours should be advised.[2]​ Artificial light is indicated for moderate to serious symptoms as an adjunctive treatment.[5]

Consider – melatonin

Back
ACUTE
|
long stay in new time zone (>2 days)
|
eastward travel
Consider – 

melatonin

Additional treatment recommended for SOME patients in selected patient group

Melatonin therapy can be considered for the treatment of moderate to severe symptoms associated with jet lag.​[5][8][11][13][14][15][16]​​​ Exogenous melatonin should be taken about 5-7 hours before normal bedtime at home on the preflight day, and then at bedtime in the new time zone for 4 days.

Primary options

melatonin: 2-5 mg orally (immediate-release) as a single dose 5-7 hours before bedtime on preflight day, followed by 2-5 mg once daily at bedtime for 2-4 days

Consider – sedative/hypnotic

Back
ACUTE
|
long stay in new time zone (>2 days)
|
eastward travel
Consider – 

sedative/hypnotic

Additional treatment recommended for SOME patients in selected patient group

The use of sedatives/hypnotics should be limited to treating acute insomnia of jet lag.[8][11]

Zolpidem given for 3 consecutive nights, starting with the first night's sleep at the new destination, has been shown to improve sleep in some travellers.[11][18] However, there is a risk of rebound insomnia after discontinuation of the sedatives/hypnotics.

Short-acting benzodiazepines can be used; however, their use with alcohol has the risk of causing amnesia during a flight. One study showed improved sleep quality following eastward travel with temazepam.[19]

Primary options

zolpidem: 5 mg orally (immediate-release) once daily at bedtime when required; 6.25 mg orally (extended-release) once daily at bedtime when required; higher doses may cause next-morning drowsiness and are not recommended, especially in women

OR

zopiclone: 3.75-7.5 mg orally once daily at bedtime

OR

temazepam: 10-20 mg orally once daily at bedtime

1st line – phase-delay light exposure

Back
ACUTE
|
long stay in new time zone (>2 days)
|
westward travel
1st line – 

phase-delay light exposure

Patients travelling westward need to phase-delay. This can be achieved by light exposure during the evening, and avoiding early morning exposure to light. Wearing sunglasses during morning hours should be advised. Artificial light is indicated for moderate to serious symptoms as an adjunctive treatment.

Consider – melatonin

Back
ACUTE
|
long stay in new time zone (>2 days)
|
westward travel
Consider – 

melatonin

Additional treatment recommended for SOME patients in selected patient group

Melatonin therapy can be considered for the treatment of moderate to severe symptoms associated with jet lag.​[5][8][11][13][14][15][16]​​​ Melatonin should be taken at bedtime or even later in the new time zone.

Primary options

melatonin: 2-5 mg orally (immediate-release) once daily at bedtime

Consider – sedative/hypnotic

Back
ACUTE
|
long stay in new time zone (>2 days)
|
westward travel
Consider – 

sedative/hypnotic

Additional treatment recommended for SOME patients in selected patient group

The use of sedatives/hypnotics should be limited to treating acute insomnia of jet lag.[8][11]

Zolpidem given for 3 consecutive nights, starting with the first night's sleep at the new destination, has been shown to improve sleep in some travellers.[11][18] However, there is a risk of rebound insomnia after discontinuation of the sedatives/hypnotics.

Short-acting benzodiazepines can be used; however, their use with alcohol has the risk of causing amnesia during a flight. One study showed improved sleep quality following eastward travel with temazepam.[19]

Primary options

zolpidem: 5 mg orally (immediate-release) once daily at bedtime when required; 6.25 mg orally (extended-release) once daily at bedtime when required; higher doses may cause next-morning drowsiness and are not recommended, especially in women

OR

zopiclone: 3.75-7.5 mg orally once daily at bedtime

OR

temazepam: 10-20 mg orally once daily at bedtime

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Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

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