stockexchanger

Ok, this is going to sound a little nutty...but this is about jet lag and I thought the Asia board had the real pros
I have always taken ambien to sleep on the way over on a flight (I don't sleep very well on planes otherwise). But there is a new drug out called Provigil, it is actually for narcolepsy. My husband is a physician and wants to try it or the first day to keep us awake so we get directly on the right time schedule. Has anyone tried this yet? I know people always mention ambien. But haven't heard anyone mention provigil yet. ??? Evidently it does not make you feel racy or speedy....just keeps you awake.
I have tried all the natural ways mentioned on the site before....but it still take me a few days. Must be my old age....in my 40s now

Kathie

I read an article recently about provigil and how some physicians were prescribing it for off-label uses such as you mention. The article was warning that there has been no research on other uses and that there are reasons to believe that there may be problems with other uses.

People are very diferent in how they respond to jet lag. There is plenty of research to indicate that it isn't just a sleep problem, it's a circadian cycle problem. When your body has not adjusted to the time zone, people have more difficulty with problem solving and judgment. This can be a major problem for people flying many time zones away who have to make complex business decisions, or for pilots, etc.

The one drug that has been studied in relation to jetlag is melatonin. There was early research evidence that it actually alters one's body clock to adjust to a time zone more quickly. However, some recent research calls this finding in to question. The original research used pilots and flight attendants and tested cognitive funstioning with and without melatonin. About 30% of people are non-responders to melatonin. If you are a responder, taking melatonin 30 minutes prior to when you want to fall asleep in the new time zone once you arrive (NOT on the plane) and augmenting it with early morning exposire to sunlight can be pretty effective in combatting jetlag.

The use of Ambien to sleep on an airplane is also contraversial. For one thing, it prevents you from moving around, so is believed to increase the chances of deep vien thrombosis. There have also been a number of reports of "untoward incidents" with the use of Ambien - confusion, even paranoia, and of amnestic problems. A colleague of mine used Ambien on a flight, arrived in Paris to change planes to Nice, felt great, but left the plane with none of his belongings, boarded his next plane...

In any case, expect it to take you at least a few days to feel like you're in the new time zone. Cognitive research has shown that it takes one day per time zone crossed to fully acclimate to a new time zone. So if you are doing a day for night switch, expect it will take almost two weeks to be functioning as effectively as usual in the new time zone!

emd

stockexchanger: I don't think it sounds nutty at all. I am concerned about jet lag on (my first) Asia flight also, as I get very very messed up without sleep- I get major disoriented and cranky and just can't really function if I do not address jet lag, get acclimated, and sleep. I have heard about Provigil. I am a former R.N. and for last 20 yrs. have done FDA-related regulatory and medical-legal work, and my specialty is adverse drug reactions. Just me, but I don't take drugs that are new on the market unless I need them for the approved indication. For off-label indications, I let the data build up in terms of exposure, and see where the safety comes out. Maybe because I've seen and worked on too much in the way of unexpected and unpredicted adverse effects. I do take melatonin. I don't use anything other than melatonin and OTC sleep aids to help w/jet lag, because I find that RX sleep aids just grog me and makes it more difficult to get acclimated. The melatonin helps alot. Personally, I wouldn't take a med to keep me awake. I plan to stay awake on the plane (leaving at 8 a.m. from D.C.) and will try to stay awake til we get into Narita and from Narita to Yokohama and can then crash (so it will be like 3 to 4 a.m. in my head then I think). Hope when we get to Yokohama to then take some diphenhydramine (I am traveling w/a 13 yr old son, so feel I can give him that safely also) and sleep and maybe (haha, right?) wake up at some type of Japan time the next day. But then I haven't been to Asia yet, just Europe many times. So ask me in a year from now when I get back from that first Japan trip. I am trying to get it across to my son that we need to stay very flexible the first few days to just see how we feel and not have incredibly set plans taht we can';t switch to another day, etc. But being 13, he is invincible and just looks at me like I am nuts.

BTW, my husband's neurologist just prescribed strattera (atomoxetine HCl) for him. This is a newly approved med for ADHD, non-stimulant, selective nonephinephrine reuptake inhibitor. He does not have that diagnosis, it was prescribed off-label for a longstanding fatigue-type syndrome (I have issues w/this). I wonder if people will start using that to stay up re jet lag.
I will look at the data on Provigil -- now that you've raised it in this context, I am interested. I am reluctant to try to stay up- I think that could screw me up even more than being tired. But that's just me.

BTW- anyone who has comments on the proposed plan to stay awake for all those hours til we get to Yokohama, I welcome input. Should we abandon that and catch some sleep on the plane? My instinct says to stay awake and get on the clock of the country where we are going as soon as possible. But that is based mostly on the shorter Europe trips.

I am glad you raised this topic.

KimJapan

Not a drug expert at all, but a jet lag pro for sure.

Over the past 9 years, we've flown between Japan and Boston many, many times. The time difference is 13 or 14 hours...upside down, totally.

My experience is that the time change from US to Japan is harder to manage than from Japan to the US. When we return to Japan after a stint in the states, we DO sleep on the plane whenever possible. My husband and I have both tried the stay awake on the plane way, and found ourselves completely exhausted upon arrival and much less functional for days after. If we sleep a bit on the plane...say 3 hours or so, the time goes by quicker, and we are much better in terms of adjusting. We arrive in either Osaka or Nagoya in early evening, have dinner, watch some TV, and sleep when we get tired. ALWAYS we are up before 4:00 AM...ALWAYS. For the next few days, we count on being tired in the afternoon and very early bedtime and waking. We kind of just accept that our body clock has to adjust and let it. For us, it works better than fighting it. The times that we have had to fight it, for work, have been very, very unpleasant, and I always ended up sick (though my husband never did). Your body clock doesn't magically adjust to a new time zone no matter what you do. Some people are bothered more by jet lag than others, though. Kathie mentioned it takes a day for every hour in time difference, and I'd say that's pretty accurate. That doesn't mean you have to sleep your vacation days away...just be aware and schedule accordingly...a 9 pm dinner reservation on day 2 will almost surely be unpleasant. Plan to be up early and asleep earlyl and enjoy it.

The early waking in Japan could be to your advantage...you can go to the early morning fish market in Tokyo, see the sunrise, take a walk before it gets hot, see the cities wake up.

rkkwan

There's a difference between day and night departure from N. America to Asia, and people react to them differently.

And this is about sitting in coach. If you're having a first class suite, ignore this post. But I know stockexchanger isn't.

If you take the day departure, you'll probably have to get up early to get to the airport, and you probably didn't sleep well the night before. During the flight to Asia, you'll take a few naps, watch some movies in between, etc; but no long sleep. You arrive late afternoon or early evening. After getting to your hotel, you'll be pretty tired, and shouldn't have problem sleeping. Get up early the next morning and have a fun day. Your jet-lag is cured.

If you take late departures (like the SQ from EWR-SIN), you'll be running around town all day, go to airport, etc... By the time they finish serving you supper, it'll be like 1am (SQ 21 departs 23:00). I am sure you'll be so tired that you can sleep for at least 5-6 hours. The next 12 hours or so, you'll probably watch several movies, nap a little, etc.

Here's the tough part. You'll be pretty tired when the plane arrives in SIN, but you won't get to Bali until around lunch time. Check-in at the hotel, and I'm sure you really want to sleep. Somewhat similar to flying to Europe with a connection. I suggest you only take a nap, and then go out until late; or don't nap, go out, and have early dinner, then go to bed. MAKE SURE YOU DON'T SLEEP for 10 hours after getting your room at the hotel, and getting up at 2am. You'll never recover.

Coming back, the main factor is how busy your life is at home. You won't have a problem with jet-lag if you live a busy life. And if you don't have a busy life, then who cares if you have jet-lag for a while...

stockexchanger

Great input!
As you know rwkkn (did I get the letters right?) we are taking the midnight flight from EWR to Singapore. But we are going to stay in Singapore for 3 days before Bali. My reasoning = it is one of my favorite cities, and no trouble finding things to do late at night there while trying to adjust to time vs. Bali where I am sure there are no food stalls open at 1 a.m.
So in this case, since we are arriving at 5:30 a.m., what is your suggestion?
Bear in mind we have a 14 year old son and twin 11 year old daughters included here.

I forget the screen name of the RN who posted....but I know what you are saying about not taking drugs before they are approved for a certain thing. I have no trouble with ambien, have used it on flights to Europe and Australia and Asia. I don't get disoriented, as some have mentioned. But my husband (as I mentioned he is a physician) consulted with Cephalon during the development of Provigil and he is very set on trying it out (and totally comfortable with it for whatever reason). I guess he figures it is only for a day or two.
My biggest concern is my kids, and how to help them adjust. They are great travelers and have been through Europe etc....but I have never tried to flip their time clock upside down. Although I have been told they adjust much more easily than we do!!
So at least my husband will try to Provigil and I will let you know if I give in and try it as well. Either way I will report back.

But truly I am curious about any ideas for young teens, and arriving in Singapore at 5:30 a.m. what you guys would all do. I know I usually can't help but crash for a while....at least a couple of hours. My thought was to sleep a few hours, then force ourselves to get up by noon at the latest. What do you think?
I do agree with whoever said it takes a couple of weeks...the only time I've felt truly adjusted was when we were lucky enough to have 6 weeks in NZ/Australia....otherwise I never quite feel myself.
Thanks again

stockexchanger

One more thing...
My husband just told me (after telling him about replies here about Provigil) that all of the fighter pilots in the military are now using Provigil for jetlag. The military is giving it to them. He says there is a good bit of military research on it and that it works well. It keeps you awake but keeps you from having rapid heartbeat, etc. but lets you fall asleep when you want to sleep. I wonder if anyone will post here who has actually tried it.

sandi

Have to agree with Kathie about not using a new med Provigil off-label, for right now. And especially for this long trip ahead of you, not knowing the reactions.

What I might suggest is that your husband to try Provigil while still at home and see if there are any reactions or changes not expected.

As far as the children, I wouldn't give them anything, unless their pediatrician prescribes something, which I doubt. Somehow they'll probably adjust, though the first day might find them testy, then maybe not, if they're kept busy.

Personally, I rarely have jet lag problems. That said, I've found that on long flights (i.e., JFK/SFO/SYD) I departed JFK on a 12N flight, had a 8-hrs layover (it was Thanksgiving and my originally scheduled later departure from NY had been canceled), then boarded flight to SYD and arrived about 7:30-8am (next day + 1). When we arrived at hotel, we showered, changed clothing and were out in the sun for the day. We should have pushed ourselves to stay out till 8pm, but didn't; instead returned to hotel for nap planning to got for dinner about 8 or 9pm. Instead we slept thru to about 3am and prayed we'd get back to sleep. Thankfully we did, and were fine the remainder of the next 16-days.

On the other side, we arrived in Thailand after departing JFK 1pm, with a 2-hr layover in NRT and arriving BKK at 11pm. Went straight to hotel and bed and were up next more bright and ready for another flight to Siem Reap. That night in Siem Reap we had problems sleeping, as we did most every night our remainder of time in SEAsia. While we had no problem falling asleep, we were up in the middle of the night, but did fall back to sleep. Both of us attributed it to the ungodly heat and humidity regardless the fact that our hotels were air conditioned and fact that we took an Ativan before sleep every night (one night even took an Ambien and that didn't work any better).

On trip to South Africa, another long long trip, we arrived at night and slept fine that night and were doing great the next day. For me, "jet lag" or maybe sheet exhaustion hit on the 6th day, but a good nights sleep and I was fine thereafter.

I believe the rule of thumb is that when arriving at night, go to sleep. Arriving during the day it's to stay up to as close to dark or near sleep time and sleep. Then you should be fine.

But everyone reacts differently, even with taking meds to sleep on a plane. And I always manage to sleep 5-6 hours each leg (if not non-stop flights) but do definitely get up in between to walk around, drink water and exercise, even when we've been in Business Class.

But if it's so much of a concern and if you're going to be in SIN for a few days before going on to Bali - then sleep that day and forget about it, and hope that by the next day you're doing okay. Don't be surprised though that you find you're up in the middle of that first night and that defeats the purpose.

I wouldn't worry so much about taking the Provigil for getting "on the right time schedule" rather what you're going to do to keep yourself busy so as not to think about the time and instead enjoy your vacation.

emd

stockexchanger: Do let us know how the Provigil goes. For the record, I certainly respect the practice of medicine and the good that can come out of off-label use of medications. Even FDA doesn't try to regulate that (to their credit). But you just have to balance the risks/benefit ratio and see where you end up.
I will do some research this week on Provigil as my interest is up now, will look at the clinical trials and off-label use reports in pilots. Thanks for raising this very interesting topic.
As for my 13 yr old son, I will give him melatonin. Like Kathie, I am familiar w/the research. And I do feel comfortable w/OTC diphenhydramine (benadryl) w/him- it gets him to sleep easily and he wakes w/no drug hangover from it. I won't give him anything else, even though he is 5' 10" and 150, he is still just 13- and I think the benadryl will be enough to take the edge off when he needs to sleep a little later than his internal clock will let him the first few days.

stockexchanger

I will keep you posted.
Evidently there IS an FDA approval letter about the use of Provigil for jet lag. Here is an article that you might find of interest....not that I would ever use it for long periods of time but I found this is interesting nonetheless:
<<Provigil. It was a drug originally developed to treat narcolepsy, the inability to stay awake. Now Cephalon, the maker of Provigil, has received a letter of approval from the FDA extending the approved uses of the drug to treatment of jet-lag and swing-shift syndrome. In reality the the drug is set to replace the caffeine in No-Doze as the all-nighter anti-sleep aid of choice. In fact, it's much better than No-Doze - with Provigil, you can literally stay awake for days, alert and with a remarkable lack of side effects. For example, a 1995 Canadian study showed that subjects taking the drug were able to perform well on cognitive tests while remaining awake and in good spirits for two and a half days. "This drug is going to bring up some very interesting ethical dilemmas," says Dr. Mark Mahowald, director of the Minnesota Regional Sleep Disorders Center in Minneapolis and an expert on the causes of daytime sleepiness. "Do you prescribe a stimulant medication for someone who is intentionally sleep deprived?"

For soldiers, the answer is yes. In another study, published in 2000, U.S. Army helicopter pilots stayed awake for 40 hours while being called upon periodically to perform maneuvers on a flight simulator. Unmedicated, the aviators became sloppy and made errors in the early morning hours. But while taking Provigil during a second 40-hour marathon, their skills and focus never wavered. Army psychologist John Caldwell, who conducted the latter study, says more research is needed to determine whether dosing soldiers with Provigil is a safe and effective way to promote alertness. However, he says, it's possible that one day the drug could be used "as an emergency measure to briefly overcome fatigue in 'must-do' missions where total sleep deprivation is unavoidable."

rkkwan

I think the key is don't sleep all day after you arrive at Singapore. Definitely take a nap, but set the alarm (or arrange a "morning" call) for the early afternoon, and then go out until late in the evening for the first day.

[Come to think of it, that's what I recommend anybody to do for everyday in Singapore, without or without jet-lag. It's hot and humid in the afternoon. A little nap is excellent, and then stay up later.]

And I'm sure your kids will be pretty happy with the entertainment choices on the SIA flights - all the movies and video games will keep them up for most of the flight (after the initial sleep).

DaveN

When we travelled from Detroit to Bejing my wife and I tried Ambien 5mg. She had a drink before the Ambien and I did not. I slept for a couple of hours and then was awake for the remainder of the flight. She slept for almost the entire flight.

On our return, I took Ambien 10mg. Being in my 40's and weighing 180 that isn't too large of a dose. Well, I still slept only a few hours but when I awoke I had double vision for 1 hour! I was quite surprised.