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SLEEP
MEDICINE

Melatonin, a hormone synthesized
from tryptophan, is a neuro-hor-
mone produced by the pineal body
and acts on the MT1 and MT2 re-
ceptors. It is secreted at night and sig-
naled by daylight. It is most
beneficial when taken a few days be-
fore and after the travel. The dosage
varies, and there are fewer side ef-
fects. Different dosing is recom-
mended for westward and eastward
travel.
Several melatonin dietary supple-
ments are on the market. These are
not FDA-regulated. Therefore, at the
present time, it is essential to know
that the dosage, duration of therapy
and purity of supplements need fur-
ther study. High melatonin-contain-
ing foods are eggs, fish, nuts (almond
chronic jet lag. Studies in animal models have shown that melatonin and pistachio), gogi berry, cherries, germinated legumes and cereals.
regulates the circadian expression of what are called clock genes.
Symptoms of jet lag include fatigue, irritability, difficulty concen- Melatonin use in children
trating, digestive disorders, insomnia, memory loss, anxiety, dizziness A 2022 study found that melatonin use increased in the U.S. by 150
and headache. The duration of jet lag is based on the number of time percent between 2016 and 2020. This availability in homes has in-
zones crossed. There is a 7-hour time difference between Amsterdam creased accidental ingestions by younger children and intentional in-
and San Antonio. I was traveling alone and stayed overnight in Ams- gestion by teens. The U.S. Poison Control Center reports that from
terdam, which I reached very early in the morning. The hotel room was- the year 2012 to 2021, ingestion by children under 19 years increased
n’t available until 3:00 p.m. So, I took a city tour. One of the stops was from 8,337 to 52,563. Common symptoms are drowsiness, increased
a diamond factory that Amsterdam was known for. Diamonds as big bedwetting, headache, dizziness and agitation. There is some concern
as marbles were displayed. The store manager jokingly said we could that melatonin could interfere with hormones and delay puberty.
try any of them on. All the women were grabbing the rings and trying Reading the published reports in preparation for writing this article
to push them onto their fingers. I fell asleep sitting in front of a tray of gave me an understanding of the universe I least expected. Circadian
diamonds. The lack of concentration and fatigue is overwhelming with (Circa-about, Diem-Day) is an autonomous timing system that has a
jet lag; no diamond could keep me awake. A day per zone traveled is 24-hour cycle that is programmed by natural light and darkness. It ex-
needed to overcome jet lag. Traveling from San Antonio, I crossed one ists in the most primitive organisms like the drosophila, fungi, bacteria
time zone to New York, two more to Frankfurt, and one more to Mum- and plants. It even affects seasonal variations in hot and cold, ocean
bai. It would take four days to get over jet lag. waves, feelings and mood. The universe's interconnectedness forces us
to respect everything we are with.
Steps one could take to mitigate jet lag:
• Gradually adjusting sleep schedules Rajam Ramamurthy, MD, is the Professor Emeritus in the
before the travel. Department of Pediatrics/Neonatology at UT Health San An-
• Proper hydration. tonio. She is a Past President of the Bexar County Medical Society
• Exposing oneself to natural daylight and serves on the Publications Committee.
at the destination.
• Use of medications like melatonin.

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