Some chronobiological and physiological problems associated with long-distance journeys

The impact of long haul travel on the sleep of elite athletes

In order to manage and implement strategies to alleviate the symptoms of jet lag it is essential to assess the impact of jet lag in athletes. The aim of this study was to assess the impact of long haul eastward travel on elite athletes' (n = 7 elite national track cyclists; male n = 3, and female n = 4) sleep. The athletes' sleep was monitored before, during and after travel using both actigraphy and self-report measures. Participants wore an activity monitor for 5 days prior to travel, during the long haul travel and 5 days upon arrival at their destination and completed a daily online sleep diary Actigraphy highlighted significant reductions in time in bed, total sleep time and sleep efficiency (%) due to long haul eastward travel, particularly in the 48 h after travel. Sleep diary data exhibited significant reductions in time in bed, total sleep time, sleep efficiency, sleep quality and a significant increase in fatigue going to bed as a result of long haul eastward travel. In order to facilitate the development of interventions to reduce the symptoms and severity of jet lag objective and subjective assessments of sleep should be coupled with assessments of chronotype and perceived sleep need.

Travel Across More Time Zones Results in Worse Perceived Fatigue and Sleep in National-Team Footballers

PURPOSE

This study investigated the association between (1) time zone difference and (2) travel direction (east vs west) with posttravel changes in perceptual responses of national-team footballers.

METHODS

Travel schedules from 355 national-team trips (50 elite soccer players) were verified using an online flight database. All players provided perceptual ratings of fatigue, sleep quality, soreness, and stress to calculate changes in scores up to 2 days after travel. Trips were categorized as <3, 3 to 6, 6 to 9, or 9+ time zone changes, along with travel direction (eastward or westward). The pretravel to posttravel changes in perceptual ratings at days 1 and 2 postarrival were compared between time zone change and travel direction with linear mixed models.

RESULTS

For every time zone crossed, poorer ratings of perceptual fatigue (β = 0.068, P < .001), sleep (β = 0.095, P < .001), soreness (β = 0.0049, P < .001), and total wellness (β = 0.214, P < .001) were observed. However, the models explained only small proportions of the variation in postflight perceptual responses (7%-18%). Regardless, travel across 9+ time zones resulted in significantly worse perceived fatigue, sleep, and total wellness for days 1 and 2 postarrival compared with travel with <6 time zones (P < .05). Additionally, fatigue, sleep, and total scores were worse on day 2 following trips of 9+ time zones. Eastward travel resulted in poorer sleep ratings (β = 0.52, P < .001) than westward travel within time zone groupings.

CONCLUSIONS

Perceptual ratings of fatigue and sleep become progressively worse as travel increases in national-team soccer players, especially after travel across 9+ time zones and eastward travel.

Sleep during travel balances individual sleep needs

Travel is expected to have a deleterious effect on sleep, but an epidemiological-scale understanding of sleep changes associated with travel has been limited by a lack of large-scale data. Our global dataset of ~20,000 individuals and 3.17 million nights (~218,000 travel nights), while focused mainly on short, non-time-zone-crossing trips, reveals that travel has a balancing effect on sleep. Underslept individuals typically sleep more during travel than when at home, while individuals who average more than 7.5 hours of sleep at home typically sleep less when travelling. The difference in travel sleep quantity depends linearly on home sleep quantity and decreases as median sleep duration increases. On average, travel wake time advances to later hours on weekdays but earlier hours on weekends. Our study emphasizes the potential for consumer-grade wearable device data to explore how environment and behaviour affect sleep.

Impacts of travel distance and travel direction on back-to-back games in the National Basketball Association

STUDY OBJECTIVES

Travel fatigue and circadian disruptions are known factors that can hinder performance in professional athletes. The present study focused on travel distance and direction on back-to-back games over the 2013-2020 seasons in the National Basketball Association (NBA).

METHODS

The outcomes were based on winning percentage with additional covariates including the direction of travel (eastward or westward), the distance traveled (0-500 km; 501-1,000 km; 1,001-1,500 km; 1,501 km and more), team quality, and season. If a team played both games of a back-to-back sequence on the road, they were considered Away-Away; if a team played the first game of a back-to-back sequence at home they were considered Home-Away; if a team played the first game of a back-to-back sequence on the road they were considered Away-Home.

RESULTS

The sequence Away-Home significantly increases the likelihood of winning compared with the Away-Away and Home-Away sequences: 54.4% (95% confidence interval [CI], 54.4%-54.5%), 39.2% (95% CI, 37.2%-41.2%), and 36.8% (95% CI, 36.7%-36.8%), respectively. When teams travel back home, every additional 500 km reduces the likelihood of winning by approximately 4% (P = .038). Finally, after withdrawing the Away-Home sequence, traveling eastward significantly increases the chance of winning (P = .024) compared with westward travel but has no significant impact on the probability of winning compared with neutral time zone travel (P = .091).

CONCLUSIONS

The accumulation of travel fatigue and the chronic circadian desynchronization that occurs over the NBA season can acutely disturb sleep and recovery. It appears that tailored sleep and recovery strategies need to be dynamically developed throughout the season to overcome the different challenges of the NBA schedule.

CITATION

Charest J, Samuels CH, Bastien CH, Lawson D, Grandner MA. Impacts of travel distance and travel direction on back-to-back games in the National Basketball Association. J Clin Sleep Med. 2021;17(11):2269-2274.

Subjective Sleep Patterns and Jet Lag Symptoms of Junior Netball Players Prior to and During an International Tournament: A Case Study

PURPOSE

To assess the impact of long-haul transmeridian travel on subjective sleep patterns and jet lag symptoms in youth athletes around an international tournament.

METHODS

An observational descriptive design was used. Subjective sleep diaries and perceived responses to jet lag were collected and analyzed for a national junior netball team competing in an international tournament. Sleep diaries and questionnaires were completed daily prior to and during travel, and throughout the tournament. Results were categorized into pretravel, travel, training, and match nights. Means were compared performing a paired Student t test with significance set at P < .05. Data are presented as mean (SD) and median (minimum, maximum).

RESULTS

Athletes reported significantly greater time in bed on match days compared with training (P < .001) and travel (P = .002) days, and on pretravel days compared with travel (P < .001) and training (P = .028) days. Sleep ratings were significantly better on pretravel days compared with match (P = .013) days. Perceived jet lag was worse on match (P = .043) days compared with pretravel days. Significant differences were also observed between a number of conditions for meals, mood, bowel activity, and fatigue.

CONCLUSION

Youth athletes experience significantly less opportunity for sleep during long-haul transmeridian travel and face disruptions to daily routines during travel which impact food intake. Young athletes also experience disturbed sleep prior to and during competition. These results highlight the need for practices to alleviate jet lag symptoms and improve the sleep of young athletes traveling for tournaments in an effort to optimize recovery and performance.

The Travel Demands of an Elite Rugby Sevens Team: Effects on Objective and Subjective Sleep Parameters

PURPOSE

To explore the effects of travel related to international rugby sevens competition on sleep patterns.

METHODS

A total of 17 international male rugby sevens players participated in this study. Actigraphic and subjective sleep assessments were performed daily during 2 separate Sevens World Series competition legs (Oceania and America). The duration of each competition leg was subdivided into key periods (pretour, precompetition, tournament 1, relocation, tournament 2, and posttour) lasting 2 to 7 nights. Linear mixed models in combination with magnitude-based decisions were used to assess (1) the difference between preseason and key periods and (2) the effect of travel direction (eastward or westward).

RESULTS

Shorter total sleep time (hours:minutes) was observed during tournament 2 (mean [SD], 06:16 [01:08]), relocation (06:09 [01:09]), and the pretour week (06:34 [01:24]) compared with the preseason (06:52 [01:00]). Worse sleep quality (arbitrary units) was observed during tournament 1 (6.1 [2.0]) and 2 (5.7 [1.2]), as well as during the relocation week (6.3 [1.5]) than during the preseason (6.5 [1.8]). When traveling eastward compared with westward, earlier fall-asleep time was observed during tournament 1 (ES - 0.57; 90% CI, -1.12 to -0.01), the relocation week (-0.70 [-1.11 to -0.28]), and the posttour (-0.57 [-0.95 to -0.18]). However, possibly trivial and unclear differences were observed during the precompetition week (0.15 [-0.15 to 0.45]) and tournament 2 (0.81 [-0.29 to 1.91]).

CONCLUSION

The sleep patterns of elite rugby sevens players are robust to the effects of long-haul travel and jet lag. However, the staff should consider promoting sleep during the tournament and relocation week.

Managing Travel Fatigue and Jet Lag in Athletes: A Review and Consensus Statement

Athletes are increasingly required to travel domestically and internationally, often resulting in travel fatigue and jet lag. Despite considerable agreement that travel fatigue and jet lag can be a real and impactful issue for athletes regarding performance and risk of illness and injury, evidence on optimal assessment and management is lacking. Therefore 26 researchers and/or clinicians with knowledge in travel fatigue, jet lag and sleep in the sports setting, formed an expert panel to formalise a review and consensus document. This manuscript includes definitions of terminology commonly used in the field of circadian physiology, outlines basic information on the human circadian system and how it is affected by time-givers, discusses the causes and consequences of travel fatigue and jet lag, and provides consensus on recommendations for managing travel fatigue and jet lag in athletes. The lack of evidence restricts the strength of recommendations that are possible but the consensus group identified the fundamental principles and interventions to consider for both the assessment and management of travel fatigue and jet lag. These are summarised in travel toolboxes including strategies for pre-flight, during flight and post-flight. The consensus group also outlined specific steps to advance theory and practice in these areas.

Sleep Hygiene and Light Exposure Can Improve Performance Following Long-Haul Air Travel

PURPOSE

To assess the efficacy of a combined light exposure and sleep hygiene intervention to improve team-sport performance following eastward long-haul transmeridian travel.

METHODS

Twenty physically trained males underwent testing at 09:00 and 17:00 hours local time on 4 consecutive days at home (baseline) and the first 4 days following 21 hours of air travel east across 8 time zones. In a randomized, matched-pairs design, participants traveled with (INT; n = 10) or without (CON; n = 10) a light exposure and sleep hygiene intervention. Performance was assessed via countermovement jump, 20-m sprint, T test, and Yo-Yo Intermittent Recovery Level 1 tests, together with perceptual measures of jet lag, fatigue, mood, and motivation. Sleep was measured using wrist activity monitors in conjunction with self-report diaries.

RESULTS

Magnitude-based inference and standardized effect-size analysis indicated there was a very likely improvement in the mean change in countermovement jump peak power (effect size 1.10, ±0.55), and likely improvement in 5-m (0.54, ±0.67) and 20-m (0.74, ±0.71) sprint time in INT compared with CON across the 4 days posttravel. Sleep duration was most likely greater in INT both during travel (1.61, ±0.82) and across the 4 nights following travel (1.28, ±0.58) compared with CON. Finally, perceived mood and motivation were likely worse (0.73, ±0.88 and 0.63, ±0.87) across the 4 days posttravel in CON compared with INT.

CONCLUSIONS

Combined light exposure and sleep hygiene improved speed and power but not intermittent-sprint performance up to 96 hours following long-haul transmeridian travel. The reduction of sleep disruption during and following travel is a likely contributor to improved performance.

How to manage travel fatigue and jet lag in athletes? A systematic review of interventions

OBJECTIVES

We investigated the management of travel fatigue and jet lag in athlete populations by evaluating studies that have applied non-pharmacological interventions (exercise, sleep, light and nutrition), and pharmacological interventions (melatonin, sedatives, stimulants, melatonin analogues, glucocorticoids and antihistamines) following long-haul transmeridian travel-based, or laboratory-based circadian system phase-shifts.

DESIGN

Systematic review Eligibility criteria Randomised controlled trials (RCTs), and non-RCTs including experimental studies and observational studies, exploring interventions to manage travel fatigue and jet lag involving actual travel-based or laboratory-based phase-shifts. Studies included participants who were athletes, except for interventions rendering no athlete studies, then the search was expanded to include studies on healthy populations.

DATA SOURCES

Electronic searches in PubMed, MEDLINE, CINAHL, Google Scholar and SPORTDiscus from inception to March 2019. We assessed included articles for risk of bias, methodological quality, level of evidence and quality of evidence.

RESULTS

Twenty-two articles were included: 8 non-RCTs and 14 RCTs. No relevant travel fatigue papers were found. For jet lag, only 12 athlete-specific studies were available (six non-RCTs, six RCTs). In total (athletes and healthy populations), 11 non-pharmacological studies (participants 600; intervention group 290; four non-RCTs, seven RCTs) and 11 pharmacological studies (participants 1202; intervention group 870; four non-RCTs, seven RCTs) were included. For non-pharmacological interventions, seven studies across interventions related to actual travel and four to simulated travel. For pharmacological interventions, eight studies were based on actual travel and three on simulated travel.

CONCLUSIONS

We found no literature pertaining to the management of travel fatigue. Evidence for the successful management of jet lag in athletes was of low quality. More field-based studies specifically on athlete populations are required with a multifaceted approach, better design and implementation to draw valid conclusions. PROSPERO registration number The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO: CRD42019126852).

What works for jetlag? A systematic review of non-pharmacological interventions

Jetlag is a combination of travel fatigue and circadian misalignment resulting from air travel across time zones. Routinely recommended interventions based on circadian science include timely exposure to light and darkness (scheduled sleep), but the real-world effectiveness of these and other non-circadian strategies is unknown. We systematically reviewed the evidence for non-pharmacological interventions for jetlag. PubMed, EMBASE, Scopus, and Web of Science were searched. Studies reviewed 1) involved human participants undergoing air travel with a corresponding shift in the external light-dark cycle; 2) administered a non-pharmacological intervention; 3) had a control or comparison group; and 4) examined outcomes such as jetlag symptoms, sleep, cognitive/physical performance, mood, fatigue, or circadian markers. Thirteen studies used light exposure, physical activity, diet, chiropractic treatment, or a multifaceted intervention to counteract jetlag. Nine studies found no significant change in the outcomes, three reported mixed findings, and one was positive. The null findings are likely due to poorly designed circadian interventions and neglect of contributors to travel fatigue. Higher quality studies that schedule darkness as well as light, in the periods before, during, and after flight are needed to reduce the circadian component of jetlag. Interventions should also address the stressors that contribute to travel fatigue.

Heart Rate and Cardiovascular Responses to Commercial Flights: Relationships with Physical Fitness

The aim of this study was to examine the influence of physical fitness on cardiac autonomic control in passengers prior to, during and following commercial flights. Twenty-two, physically active men (36.4 ± 6.4 years) undertook assessments of physical fitness followed by recordings of 24-h heart rate (HR), heart rate variability (HRV), and blood pressure (BP) on a Control (no flight) and Experimental (flight) day. Recordings were analyzed using a two-way analysis of variance for repeated measures with relationships between variables examined via Pearson product-moment correlation coefficients. Compared to the Control day, 24-h HR was significantly greater (>7%) and HRV measures (5–39%) significantly lower on the Experimental day. During the 1-h flight, HR (24%), and BP (6%) were increased while measures of HRV (26–45%) were reduced. Absolute values of HRV during the Experimental day and relative changes in HRV measures (Control-Experimental) were significantly correlated with measures of aerobic fitness (r = 0.43 to 0.51; −0.53 to −0.52) and body composition (r = −0.63 to −0.43; 0.48–0.61). The current results demonstrated that short-term commercial flying significantly altered cardiovascular function including the reduction of parasympathetic modulations. Further, greater physical fitness and lower body fat composition were associated with greater cardiac autonomic control for passengers during flights. Enhanced physical fitness and leaner body composition may enable passengers to cope better with the cardiovascular stress and high allostatic load associated with air travel for enhanced passenger well-being.

Effect of transmeridian travel and jetlag on mood disorders: evidence and implications

OBJECTIVES

Given the sensitivity of individuals with mood disorders to circadian disruption, transmeridian travel would likely be a high-risk endeavour leading to onset or relapses in mood. A systematic review was undertaken to identify the evidence of the impact of transmeridian travel on people with mood disorders.

METHODS

Databases search included the following: CINAHL, MEDLINE, PsycINFO and manual searching using the keywords jetlag, transmeridian travel, circadian rhythm disruption, mood disorder, bipolar, major depression, seasonal affective disorder, depression, mania and hypomania.

RESULTS

Only three studies were identified that related to transmeridian travel and jetlag in people with mood disorders. There is some suggestion that transmeridian travel does appear to precipitate mood episodes with an increased rate of episodes of depression with westward compared with an increased rate of manic/hypomanic episodes with eastward travel. Individuals with a previous history of mood disorder appear to be more vulnerable if adherence to medication is compromised.

CONCLUSION

Given the limited evidence that transmeridian travel precipitates mood episodes, this poses difficulties in identifying suitable ways to mitigate the effects of transmeridian travel in mood disorders. However, in the absence of mood-specific guidelines, some guidance can be given based on our current understanding of the relevance of circadian disruption to both jetlag and mood disorders. Further research is required to identify more focused strategies to mitigate the impact of transmeridian travel for individuals with mood disorders.

Time-of-Day Effects on Psychomotor and Physical Performances in Highly Trained Cyclists

The aim of this study was to examine, in trained young cyclists, whether psychomotor performances were dependent on time of day and fluctuated similarly to changes in athletic performance. 14 highly trained male cyclists ( M age = 17.3 yr., SD = 1.6; M height = 179.0 cm, SD = 0.1; M body weight = 67.4 kg, SD = 4.5) voluntarily took part in 6 test sessions, at 08:30, 10:30, 12:30, 14:30, 16:30 and 18:30. Each test session comprised a maximal-intensity exercise consisting of 2 × 10-sec. sprints (all-out exercise) preceded by an attentional performance test including 4 fields of attention performed in a randomized order at different times throughout the same day, every 2 hr. between 08:30 and 18:30. The main results indicated that attentional and physical performances depended on the time of day, with an improvement in reaction times in phasic alertness, visual scanning, flexibility, Go/No-go, and an increase in maximum power throughout the day. This study shows the daily variations in physical performances and that fluctuations are reflected in psychomotor performances. These findings suggest that cyclists' training sessions cannot be programmed throughout the day without taking into consideration the effects of the time of day, with several practical applications for coaches and athletes.

[Clinical picture and treatment of jet lag]

Symptoms associated with rapid time zone crosses represent one of the major health problems associated with commercial flights. This condition is termed jet lag that is characterized by sleep disturbances (insomnia, sleepiness), somatic symptoms, and decrease in mental and physical outputs. Difference between the light-darkness cycles of the destination and internal homeostatic rhythm is responsible for the syndrome. Restitution of the internal rhythm by appropriate light exposure or melatonin, optimal sleep time and duration, and drugs can be used in its treatment.

International travel and the elite athlete

International travel is a frequent occurrence in the life of the elite athlete; such travel can pose challenges to the sport medicine practitioner. Travel is also the reality of many recreational level or sub-elite athletes as opportunities for international competition and training proliferate. An appreciation of the range of responsibilities associated with the preparation for and the strategies to facilitate such travel is essential for any physician charged with the care of athletes and teams. An appreciation of (1) the medical and public health challenges associated with competition in a particular setting; (2) the requirements for vaccination and immunization; (3) the strategies for the management of jet lag and climatic or environmental extremes; (4) the range of supplies and equipment necessary for travel to certain locales; (5) the need to ensure the availability of ample familiar and nutritious foods; (6) the potential need for specialty care in strange settings; (7) the management of common travel-associated illness; and (8) the challenges associated with the evacuation of an injured athlete are fundamental to the successful management of international travel involving athletes and teams. The adoption of a methodical approach to pre-trip planning can ensure an enhanced travel experience, illness-free training and competition, and facilitate optimal performance.

A phase 3, double-blind, randomized, placebo-controlled study of armodafinil for excessive sleepiness associated with jet lag disorder

OBJECTIVE

To assess the effect of armodafinil, the longer-lasting isomer of modafinil, on jet lag disorder.

PARTICIPANTS AND METHODS

This double-blind, randomized, parallel-group, multicenter study was conducted between September 18, 2008, and February 9, 2009. Adults with a history of jet lag symptoms on previous flights through multiple time zones flew from the United States to France (a 6-hour time zone change) for a 3-day laboratory-based study period. Participants received armodafinil (50 or 150 mg/d) or placebo each morning. Wakefulness was assessed by the coprimary outcomes, mean sleep latency on the Multiple Sleep Latency Test (MSLT) (average of all MSLT sessions across days 1 and 2) and Patient Global Impression of Severity in relation to jet lag symptoms (averaged across days 1 and 2).

RESULTS

A total of 427 participants received armodafinil at 50 mg/d (n=142), armodafinil at 150 mg/d (n=143), or placebo (n=142). Armodafinil at 150 mg/d provided a significant benefit in sleep latency on the MSLT (days 1-2: mean, 11.7 minutes vs 4.8 minutes for placebo; P<.001) and participants' perception of their overall condition in relation to jet lag symptoms (Patient Global Impression of Severity, days 1-2: mean, 1.6 vs 1.9 for placebo; P<.05). The most frequently reported adverse events for armodafinil at 150 mg/d were headache (27%), nausea (13%), diarrhea (5%), circadian rhythm sleep disorder (5%), and palpitations (5%).

CONCLUSION

Armodafinil increased wakefulness after eastward travel through 6 time zones.

TRIAL REGISTRATION

clinicaltrials.gov identifier: NCT00758498.