Doctors Tips For Healthy Flying

There was a time when jumping on a plane was a relatively easy thing to do (assuming you had the money). But today's flying experience is often more of an ordeal than a pleasure, aggravated by concerns about terrorism, long queues for safety and security checks, and other irritants such as checking the long lists of things you can and can't take with you
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As well as the stress that precedes departure, there are the physical health issues, ranging from aching limbs, swollen ankles, and sleep disruption, to what has been popularly described as "economy class syndrome" (the possibility of deep vein thrombosis, DVT), and of course, coping with jet lag.

Yet despite these drawbacks, more of us are boarding planes than ever before. World air travel has grown by around 5% a year over the past 30 years. In 2006, the world's 2,000-plus airlines flew 23,000 aircraft carrying more than 2 billion passengers on almost 28 million scheduled flights.

Perhaps our growing predilection for air travel is explained by Dr Roy L. DeHart, an expert in aerospace medicine, who in 2003 wrote: "although there are numerous health issues associated with air travel they pale in comparison to the enormous benefits to the traveler, to commerce, to international affairs, and to the public's health."

So given there are some things we can't change about air travel, what are the things we can do something about to protect our health and ensure our comfort while flying?

This article offers you some tips garnered from various sources, including official advice from medical and travel experts, as well as from frequent travellers' personal experiences, on how to minimize the effects of jet lag, increase your comfort and chances of getting some good sleep on board, and also tips on exercises and reducing the risk of DVT.

Jet Lag

Jet lag is the result of travelling across several times zones, causing symptoms like fatigue and sleep disruption. Our biological clock is attuned to the day-night cycle of the start of our journey, so when we travel to a different time zone quickly, as we do when flying, our body is still functioning as if we were in the time zone we have left behind. It can take anything between 2 days and 2 weeks for it to adjust completely to the new time zone, depending on how far you have travelled.

Also, you may find that different body rhythms adjust at different rates. For example, digestion can adapt more quickly than sleep.

Here are some tips to minimize the effects of jet lag:

• Set your watch to the time zone of your destination before you depart.
• If you are flying WEST (eg Paris to Vancouver, Bangkok to London): stay awake as long as you can when you get there. It is easier to endure a longer day that it is to shorten your body's natural rhythm. Also, if you can, try going to bed and getting up later for a few days before you travel.
• If you are flying EAST (eg Mexico City to Frankfurt, Johannesburg to Sydney): try to sleep on the plane while it is night time at your destination. When you arrive, try not to sleep during the day, or it will take longer for your body clock to change to the new time zone. You can also prepare for the adjustment by getting up and going to bed earlier for a few days before you travel.
• When you arrive at your destination, get into the local routine as soon as possible.
• At your destination, try to stay outside during daylight as much as you can (while being sensible about sun exposure and sunburn risk), because natural light helps your body clock to adjust.
• If you have travelled west, go outdoors in the morning and stay indoors in the afternoon for the first few days: if you have travelled east, avoid morning light and try to get more outdoor light in the afternoon.
• If you are going on a short trip, for instance if you are a member of aircrew or a business person going to a meeting, then it doesn't make sense to try and adapt to the local time zone, you are probably best advised to keep to your home time zone.
• If your business meeting is very important, getting there a half or full day early will give you more time to adapt and be fully alert. Alternatively, try to schedule it to coincide with daytime in your home time zone.

Some research has found that taking Melatonin at bedtime in the new time zone is effective for about 50% of people, but clinical studies have not yet been done to prove it is safe and effective and at what dose. According to the Civil Aviation Authority (CAA) the UK's specialist aviation regulator, aircrew are not allowed to use it. Melatonin is a hormone that is stimulated by darkness and suppressed when it is light.

Some people swear by sleeping tablets, but healthcare provider BUPA warns you should first talk to your doctor before using them on flights and for jet lag. He or she may advise you take them just for a couple of days while your body clock adjusts. But you shouldn't take them in flight because this will encourage you to sit still for too long which increases the risk of DVT (more about this later). Also, you should not drink alcohol when taking sleeping tablets, as this can make you even sleepier and therefore less mobile.

Comfort and Sleep

Many people find it difficult to sleep on a plane, and no wonder, when you consider all the distractions, noises, children crying, light streaming in through the window (daylight is very bright at 35,000 feet!), and to cap it all, you don't have enough leg room, you feel cold, your shoes are too tight, and it's not easy to sleep upright!

Well, even with these disadvantages stacked against you, the following tips may ease in enough comfort to enable you grab a few hours of good sleep on your next long haul flight:

• Choose your seat wisely. This advice comes from the editor of independenttraveler.com, who suggests you pick a window seat so you can lean against it (it also gives you control over the sunshade!) and stay out of the way of people climbing over you or going up and down the aisle and leaning into or falling against you just as you are dropping off.


• Also, think twice about reserving exit row and bulkhead seats, sometimes the advantage of extra legroom is outweighed by armrests that don't raise and seats that don't recline (so they don't cause an obstruction in an emergency). This could also be a noisy section of the airplane as these seats are often reserved for families with young children.


• The same goes for the last row: the seats may not recline and if they are near the toilets, you could be troubled by noise and smell!


• Check out Seat Guru from tripadvisor: tap in the flight number and you can see the layout of the plane and review advice on the pros and cons of different seating areas.


• Take only one small bag as hand luggage, so you don't have to jam one under your feet and restrict your legroom. Keep all the things you are going to need on the flight at the top of the bag, and put a few in the pocket of the seat in front, but not too many or the flight attendant may ask you to remove them if they bulge out and potentially obstruct passenger evacuation.


• Bring a neck pillow, an eye mask for blocking out light, and warm socks (it can get chilly down near the feet during a long haul flight).


• Some people don't find neck pillows very comfortable: try out a few. Some of the ones you blow up have an annoying seam that sticks into your skin when your head flops over! Those velvety, already-blown-up ones seem better, but try them out first.


• Wear loose, comfortable clothing and go for layers that you can peel off easily when you get too warm or put on again if you get cold, for example a loose long sleeved T-shirt and a body warmer might be more practical than a jumper.


• Wear comfortable soft shoes that you can slip on and off easily: your feet will swell during the flight.


• Board early to make sure you get your pillow and blanket: if there isn't one for your seat, tell the flight attendant and get your claim in early!


• If you are someone who can't sleep after drinking caffeine, then stay off it for a few hours before and during the flight. Remember that some soft drinks and tea also have caffeine.

Deep Venous Thrombosis (DVT)

A DVT is a blood clot in a deep vein, commonly in the legs. It is life-threatening because a piece of the clot can break off and travel to the lungs where it can cause a pulmonary embolism (a blockage of a main artery to the lung).

There has been a lot of controversy about whether flying by plane, especially on long haul journeys, raises the risk of DVT. The jury is still out about this to some extent, but several studies done as part of Phase I of the World Health Organization's Research Into Global Hazards of Travel (the WRIGHT project) suggest that the risk of venous thromboembolism (VTE, of which DVT is an example) may double after 4 hours of flying. The main cause appears to be prolonged immobility, so there is also the same risk if you sit for long periods on a long car, train or bus journey, or even at home or the office.

The longer the period of prolonged seated immobility, the higher the risk, and there is a tendency for longer flights to carry a higher risk of DVT than shorter flights for this reason. The risk also goes up with multiple flights within a short period.

The risk is raised significantly in the presence of other known risk factors for DVT, which are: being over 40, having had a DVT or blood clot in the lung before, having a history of blood clots in the family, hormonal effects of being pregnant or being on HRT or using oral contraceptives. Recent surgery or trauma, and also many types of cancer can also raise DVT risk.

The WRIGHT project found that the absolute risk of VTE per flight of more than four hours, in a cohort of healthy individuals, was 1 in 6,000.

There is some evidence that compression stockings can reduce risk of DVT in passengers on long haul flights. These are routinely used in hospital, where patients share some similar characteristics to long haul passengers: they can become dehydrated, breathe in air of low humidity, and tend to be immobile for long periods.

The CAA also recommends drinking "adequate amounts of non-alcoholic beverages" on long flights to reduce risk of DVT. There have been discussions about the pros and cons of using aspirin as a way to reduce risk of DVT, but the CAA advises against it: "the balance between benefit and harm is not in favour of aspirin and thus its routine use cannot be recommended", they say in their website's FAQ section on DVT.

Exercises

So how do you reduce your risk of DVT when flying? Well, the same way as you reduce your risk on the ground: avoid immobility, get up and walk around from time to time, and keep physically active. This can be a challenge on a crowded plane, but it is not as difficult as you might think.

Exercise not only reduces your risk of DVT, it also has other benefits, such as reducing aches and pains, relieving stress and boredom, and inducing better quality sleep. Many airlines now show suggested exercises and stretches in their On Board Information. Click here to see one of the more comprehensive ones, from TAP, the Portuguese airline.

Matthew Eaves, film maker, globe trotter and author of a book of tips on how to survive a long haul flight says "drink a bottle of water every hour; leave your seat every hour and walk up and down the plane".

Exercises you can do to relieve aching legs as well as reduce clotting risk are rotating the ankles, pushing down alternately with heels and toes, standing calf raises (go to a corner near the toilets or the galley to do these), alternately tensing and relaxing parts of the legs (working upwards from feet to thighs and hips then down again).

The back is a part of the body that often aches after a few hours flying. A good back stretch is to bring your chest down to meet your thighs while seated. Elongate the spine and hold for 5 seconds, then gently sit back upright. Repeat two or three times, and do it every hour or so.

Here's a tip from bodybuilders for the arms. Hold them out straight out in front of you, with the hands relaxed downwards. Then tense the whole of the arms and make hard fistballs with the hands. Hold for a couple of seconds, then suddenly open the fingers, until the hands are stretched out like dried starfish, then close again, hard. Repeat a few times.

Here's one for the shoulders: sit up straight, clasp hands behind the head with elbows out to the sides. Gently pull the elbows backwards while bringing the shoulder blades down and together. This is probably not one to do in your seat as you may poke your neighbours in the eye.

And finally, one for the neck: again, clasp hands behind the head and gently pull the head down onto your chest while keeping spine stretched up. Keep pulling gently until you feel the stretch at the back of the neck into the shoulders. Hold for a few seconds and repeat.

Fear of Flying

There are millions of people who have anxiety and panic attacks about flying. Fear of flying is the third most common phobia after fear of snakes and spiders. Sometimes it arises from a bad flying experience, or an emotional reaction to news about hijacking or a plane crash. It can also be triggered by claustrophobia, concern about heights, loss of control, and fear of the unknown.

If you are afraid of flying, then perhaps consider going on a course. Some airlines actually run courses that combine behavioral techniques and education about aircraft, such as the different noises they make and what causes turbulence, one of the things that can cause distress. Some of the courses also finish with a flight, under carefully controlled conditions. The CAA says research has shown that such courses are effective and that the benefit may be sustained.

Fear of Flying Help is a free online course by currently flying Airline Captain Stacey Chance that offers educational material and practical suggestions. For example in Chapter 4, Dr Arnold Bennett of MIT, gives a plausible argument for persuading you that air travel is safer than many other ways of travelling. He also discusses how news media coverage can make air accidents appear to be more frequent than they really are, and gives tips on overcoming fear of flying, such as exercising regularly, eating a healthy diet, and getting plenty of sleep to increase your resilience and reduce vulnerability to stress.

Another tip commonly given on courses is, once you are on board, rather than dwell on your fear and let anxious thoughts dominate, try to distract yourself by chatting to other passengers, watching the in-flight movie, eating, reading, or listening to your portable music player.

A tip I have found useful to control anxiety in stressful situations is breathing relaxation. We tend to forget about breathing, it happens automatically, but it is a powerful relaxation tool that we carry with us wherever we go. If you feel yourself getting anxious, notice your breath, it is interesting how anxiety and shallow, quick breathing often go together. You can make yourself calmer by focusing your attention on your breathing, and just gently pushing the anxious thoughts to one side. Feel how your lower chest cavity swells as you gently inhale with the bottom of your lungs. Then feel it go in as you exhale. Don't try to time your in and out breaths, just breath gently, slowly, deeply, naturally. 

You could also consider telling the cabin crew that you are nervous about flying - many are trained to deal with this and can reassure you about strange sounds and other unexpected things that might make you anxious. 

Traveldoctor.co.uk says if you are thinking of taking a tranquilliser before flying, you should remember that many of them do not mix well with alcohol.