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How can I prevent feeling crummy after the long flight?

The name "jet lag" is often assigned to the seedy feeling most of us will have after an intercontinental jet flight. After a long trip in cramped and stressful conditions, you find it hard to sleep, have little appetite, feel generally washed-out and perhaps have a headache or feel nauseous and disoriented. It's not a good time to tackle getting your luggage back at arrival, or to find transport into town and obtain a hotel room if you need to. Additionally, it's quite common to come down with a cold or other respiratory infection a couple of days after the flight. In one survey, over 20% of respondents said they'd developed cold or flu symptoms after a long plane journey (1).

One irony here is that with air travel, good air is what's often in shortest supply. It's whizzing around outside the plane, but you can't get enough of it to breathe comfortably. To save money, nearly all airlines run their planes to mix a proportion of recirculated air with fresh air drawn in from outside. That's because outside air needs heating (it may be fifty degrees below freezing out there), and heating uses precious energy. There may be as little as 7 or 8 cubic feet per minute (0.198 to 0.226 cubic metres per minute) of fresh airflow in economy class, although the minimum recommended by the American Society of Heating and Refrigeration and Air Conditioning engineers for airflow on ground-based ventilation systems is 20 cu. ft. per minute (0.566 cu metres/min.). If you move up to First or Business, you'll probably receive that minimum, and it might even be as high as 50 cu. ft./ min. (1.415 cu. metres/ min.). The flight deck, by the way, receives 150 cu. ft./ min. (4.25 cu metres/ min.), so you know where the airlines' priorities lie. Thus the average economy passenger breathes air which has been in and out of others' lungs more than a few times. It would cost around sixty US cents for every passenger to increase fresh air in economy from 10 to 20 cu.ft. per minute, and as competition for airfares is intense, savings in less obvious areas like cabin air are fairly easy to make without eliciting complaints from passengers.

Another problem is that the air you breathe is at the same pressure you'd experience on a mountainside between 6,000 and 8,000 feet (about 1850 to 2450m). Again, it's all to do with saving money, but this time the savings are about the construction of the airplane itself (it would need a stronger - and therefore heavier - fuselage to withstand the higher internal pressure). The end result is you'll be breathing about 20-26% less oxygen than you would at sea level. You might be strong enough not to notice this, or you might become very distressed by the low oxygen in the air. The medical term for oxygen deficiency is hypoxia, and it can result in death in extreme cases. It adds to the total stress load on your body, by making you slightly dizzy, and it can give you a headache, dry throat, ear pain, stomach pain, smarting eyes, a tight chest and swollen feet. The fact that the air comes from outside also leads to its being very dry. High altitude air has a very low humidity and the compression process in the plane further reduces the humidity. At less than 2% relative humidity, you'll be sitting on that mountainside in a desert environment drier than any desert in the world! Dryness in the air you breathe leads to dehydration of your body and adversely affects that protective film of moisture over your nasal and bronchial mucous membranes, making you more susceptible to all the airborne bugs from other passengers.

What you can do to help yourself feel fresher upon arrival:

1. Turn off the air nozzle above your seat. This is blowing the 50% recycled air directly into your face and spreading viruses and bacteria. With the low humidity in the air, you'll be set up to contact a cold if you're at all susceptible. Those of us who prefer window seats are at a disadvantage here, as even with the nozzle closed, most aircraft blow air down the insides of the walls as part of the ventialtion system, and you can't switch that off.

2. Sit as far forward in the cabin as you can. The back rows of seats receive the final remnants of air in the ventilation system and so have the worst air quality.

3. Drink plenty. You'll need to replace that water which is being sucked out of your lungs by breathing very dry air. You won't notice it going, but you'll need to replenish around two litres on a 10-hour flight. Choose still water, as aerated water or sweetened drinks may add to your feeling of bloat from the altitude. Don't ever drink water from onboard toilets - it's not treated and may give you a stomach infection.

4. Don't rub your eyes with your fingers. Germs spread fastest if they enter your eyes, and micro-droplets flying around in the air from coughs and sneezes soon deposit bugs on all surfaces inside the cabin.

5. Avoid alcohol. Drinking any alcohol on or before the flight speeds up the dehydration process, disrupts your adjustment to sleeping in a new time zone and compromises your immune system right when you want it at its strongest.

6. Move around a bit. Your circulation system should have some chance to shunt away the pooled fluid which collects in the feet and lower part of your body during prolonged periods of sitting. A stroll up and down the aisle a few times every hour is an excellent way to get exercise, and you might meet someone interesting.

7. Don't go to sleep on the flight. I'm serious; this is the single best thing you can do to fit in with the new time zone. If you have slept before you arrive, you'll not be tired enough for sleeping well once you have to go to bed at a time your body clock tells you is the middle of the afternoon at home. What's more, sleeping in the weird position guaranteed by economy class aircraft seats will leave you more fatigued when you waken than if you'd kept alert.

8. Switch to the new time zone a few days before you leave. If you have the luxury, gradually converge your meal- and bed-times to be the same as where you are going. Flying east, this means that you'll go to bed and get up earlier and earlier. Even if you are holding down a job in the days before departure, a few hours earlier to bed and rise will save you a couple of days of drowsiness at the other end.

9. Give your feet space to swell. Take off your shoes when seated, and keep a little bit of clenching activity going on in legs and feet when you remember to.

10. Eat in moderation. A full stomach makes you feel lethargic, and the digestion process itself needs more oxygen than you'd use normally - remember, oxygen is at a premium in the rarified air of the cabin. Added to that, the lower cabin pressure may cause an unpleasant bloated feeling.

You shouldn't take sleeping pills to help you adjust to a new time zone. The hangover effect upon awakening will add to the disorientation you feel, and some medical professionals think that sleeping tablets add to the time needed for adjustment. Melatonin is another case entirely. Tests have shown promising results when jet travellers taking melantonin are compared with those not taking it. Melatonin helps bring on sleep and it also supplements the natural melatonin needed to help your body clock adjust. If you are going to use it, take melatonin (available over the counter in many countries) after your flight - the drowsiness it induces may affect your ability to react to an emergency in the aircraft, and it will impair your alertness in getting a taxi or driving from the airport as well as finding accommodation without problems. It's not something to take without medical advice if you are pregnant.

References: 1: Journal of the American Medical Association, 1999. Aircraft Cabin Air Recirculation and Symptoms of the Common Cold - Jessica Nutik Zitter, MD,MPH; Peter D. Mazonson, MD,MBA; Dave P. Miller, MS; Stephen B. Hulley, MD,MPH; John R. Balmes, MD.

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