Melatonin and jet-lag.

Caused by time shift, a desynchronisation of the body clock from external zeitgebers occurs after transmeridian flight which leads to disturbances of sleep and circadian rhythms. These disturbances are not pathological and diminish within days. To achieve a faster resynchronisation than naturally, the hormone melatonin is often taken by business people and travelers, and--to some extent--by aircrew. The usefulness of the melatonin intake for alleviation of jet-lag is intensively discussed. Most field studies reporting about a favourable influence of melatonin on jet-lag, have been performed using questionnaires; few studies monitoring physiological circadian functions have found a better adjustment under melatonin treatment. However, from laboratory experiments is known that external melatonin is indeed capable to influence the circadian system. With respect to the efficacy of melatonin on better sleep and performance, there is a lack of information from field studies, and laboratory studies do not provide consistent results. Unequivocal estimations of the dosage of melatonin for best efficacy are not yet performed, although a range of different dosages have been tested. Recommendations about dosage, duration of medication and time of intake (which is of major importance for efficacy) do not rely on systematic examinations of the drug. Adverse effects of melatonin on sleepiness and impaired performance directly after intake of the drug are known. From studies is also derived that an inappropriate timing of intake causes sleep disturbances and unfavourable shifts of the circadian system. The administration of melatonin for influencing sleep and circadian rhythms cannot be recommended for aircrew. Flight physicians should refer to adverse and side effects of the hormone melatonin. Before any general recommendations for the use of melatonin can be presented, genuine clinical studies following good clinical practice should be performed.