*** Although I am a medical professional, all information, content, and material of this article is for informational purposes only and is not intended to serve as a substitute for the consultation, diagnosis, and/or medical advice of a personal physician or healthcare provider. If you have any questions or concerns regarding your personal circumstances please see your physician or healthcare team. ***

Before I begin I would like to give a big thank you to Keith Capstick for helping me with editing while also providing feedback/advice on how to make such a dense topic readable. Over the past several weeks he has taught me how one communicates is just as important as the content you are trying to communicate. An invaluable lesson that I had not fully realized or grasped until very recently. Thank you Keith.

Desynchronosis and eSports

I’ve been lucky enough to be around esports since its grassroots in North America. I have witnessed the glory years of games like Halo, Call of Duty, Starcraft, League of Legends and now Magic the Gathering. These competitions have gotten bigger than anyone could have imagined, attracting crowds that rival traditional sports while steadily becoming a global phenomenon. Although the titles have changed, the aspect that has always prevailed is live competition. In today’s esports environment it is often a requirement for competitors to travel internationally, across several time zones, to compete in their respective games leading to the phenomenon of jet lag. In an environment where competitors leverage every bit of practice and knowledge to win, every edge matters. So how important is sleep? And how much does it really matter in comparison to your preparations.

To give some reference, short term sleep deprivation is equivalent to being drunk. Being awake for 19 hours can cause the same mental impairment as a 0.05% blood alcohol level. By 24 hours impairment can resemble levels of 0.1%, enough for a serious DUI and suspension of your license. This doesn’t include the various decline in cognitive functions such as attention, reaction time, memory, and mood, all of which are absolutely crucial in a competitive gaming environment. What’s the take away? Start practicing MTGO with a fifth of vodka on hand, or start sleeping better. I’ll leave that up to the reader.

My tips will encompass the understanding of 3 broad concepts: What causes jet lag. What sleep is. And how we can manipulate this information to our advantage.

What is Jet Lag?

Jet lag, or desynchronosis, can be thought of as a temporary insomnia. Your body has a central clock and many peripheral clocks that keep your body in a 24 hour cycle called “circadian rhythms”. From this point forward I will refer to them as “rhythms”. These rhythms are daily cycles that include everything from hormonal peaks and troughs, body temperature and wake-sleep cycles.  When traveling across 5 or more time zones, a discrepancy between our daily habits and bodily anticipation of these events occur. The result is our biological clocks telling us that it’s time to sleep when it’s sunny outside, or that it’s time to walk the dog at 3:00 am. Both unwanted circumstances in competitive environments that require prolonged levels of concentration over a two day period.

What does it mean to be awake?

Before understanding sleep, an explanation of what it means to be awake should be defined.  Early neuroscientists believed that consciousness was the product of a critical threshold of incoming sensory input to the brain from the body. This theory was conceptualized by an experiment introducing a transection (shown as B) in the brainstem rendering animals unconscious. This theory was later disproven due to a subsequent experiment where a transection (shown as A) left the animals conscious. In plain English this monumental experiment showed that a point, between the levels of A and B, must be responsible for wakeful consciousness.

This spot, named the Ascending Reticular Activating System (ARAS), is an area in your brain stem which literally pumps the higher cortex full of “adrenaline” and other monoadrenergic/cholinergic chemicals to maintain arousal. It is therefore to say, in order to go to sleep, inhibition of the ARAS is necessary and the term “going to sleep” is a misnomer. A more apt way to think about sleep is a “cessation of consciousness”

Understanding Sleep and the Master Clock – The Suprachiasmatic Nucleus

Once you conceptually understand ARAS, sleep can be simply thought of as its inhibition. This inhibition is caused by a mix of direct inhibitory effects and indirect neural hormonal effects that draw contribution from a vast number of cells throughout the body. These signals are all under the influence of a master clock known as the Suprachiasmatic Nucleus (SCN), that control the rhythmic gene expression in peripheral tissues throughout your body. For simplicity I will refer to any group of cells outside of the SCN as “peripheral”. Under normal circumstances, the SCN synchronizes other circadian rhythms elsewhere in the body through a variety of output pathways yielding a rhythmic schedule of biological functions that you have come to know as your daily bodily routine.

One can think of the Suprachiasmatic Nucleus (SCN) as the conductor of an orchestra, with the peripheral tissues representing the individual musicians, all capable of generating their own music (sense of time). Analogous to how individual musicians require the conductor to be in sync, relationships between these processes are often reciprocal, such that the circadian rhythms drive temporal changes in metabolic pathways and changes in metabolic status alter core components of circadian rhythms. Through this understanding we can try manipulate and control our SCN and peripheral rhythms in order to control and reduce our jet lag.

The SCN is located within the hypothalamus (a region in the brain) and expresses a rhythm of neuronal activity that is inversely correlated with light. Light is the primary stimulus which entertains the SCN and when it hits your eye, a signal is sent to the SCN inhibiting its activity. As the day progresses, and light dwindles to twilight, this inhibitory pathway lessens allowing for an increase activity of the SCN. The SCN will then communicate through various hormonal / neural pathways in order to exert its effect. One of these pathways involves the Pineal gland which releases Melatonin that contributes to the drowsiness some experience. A big caveat here is that Melatonin acts to prime the body for sleep. This is an important distinction when comparing Melatonin to sleeping pills. Medication such as Ambien, act to directly inhibit neurons in the ARAS, literally forcing an unconscious sleep state (less beneficial with more adverse effects) where Melatonin can be thought as more of a signaling molecule, priming your body for sleep.

Peripheral Rhythms – How it Comes Together

The Nobel Prize in Physiology or Medicine 2017 was awarded jointly to Jeffrey C. Hall, Michael Rosbash and Michael W. Young for their discoveries of molecular mechanisms controlling the circadian rhythm and is currently at the forefront of research. As such the mechanisms behind peripheral rhythms are complex and not fully understood.

What is known is that physiological responses from meals, activities, hormones and metabolites all have reciprocal effects on peripheral cells that influence sleep patterns. Therefore what we eat, how much we eat, and our daily activity levels all have an influence on our sleep behaviors!

Below I’ve included a modified pictoral summary adapted from the public domain work of Jonathan D Johnston. (The larger the arrow the larger the impact on the SCN) 

The take home concept behind trying to reset your peripheral rhythms to a destination time zone is reduction in your total daily caloric consumption! The idea behind fasting is that by restricting caloric intake, in conjunction with a new feeding schedule, you introduce a stress that disrupts the rhythmic expression of genes that follow your personalized daily circadian rhythm. In this way you are introducing stress as a feedback mechanism to help your SCN reset and adapt to a new time zone schedule.

Ad libitum, “eating/sleeping according to pleasure”, would be your normal ‘breakfast’, ‘lunch’ and ‘dinner’ schedule.  In this scenario the factor that will most strongly synchronize the SCN is light usually requiring ~5ish days to overcome jet lag.

Fasting + hypoenergetic states have the most profound impact on the SCN and peripheral clocks. Under these conditions, both the SCN and peripheral clocks are strongly influence by feeding times along with light input. Hypoenergetic meals are defined by any meal that will ultimately lead to a caloric deficit relative to expenditure. For example if you are a 150 lb male burning ~2000 calories a day, then your average maintenance intake should be roughly 667 cal/meal (assuming 3 meals/day). So a hypoenergetic meal would be anything less than 667 Cal. My personal recommendation is to try go for a total of 500 caloric deficit per day. At this rate you will be burning ~1lb of fat /week putting your body into a state where part of your daily energy will come from ketones which is associated with more efficient brain function. (I’m considering a potential future article on diet/nutrition that will go into more depth on this topic)

Cool! But what does it all mean?

If there’s one thing you should take away from the above scientific mumbo jumbo let it be this:

It is much easier to RESIST the urge to sleep than to CREATE it.

To reiterate, the ARAS is constitutively active, keeping you awake. In order to sleep one must temporarily inhibit it during the period of sleep. To do this requires the buildup of metabolites in conjunction with rhythmic activity of the SCN and peripheral clocks.

If you can digest the last paragraph you can understand why it’s extremely difficult to go to bed at 10:00 PM destination time when your body thinks it’s 5:00 PM and you’re only 9 hours into your normal day. There simply isn’t enough inhibitory actions acting on the ARAS.

Simple Tips to Overcome Jet Lag

• Go to Bed Earlier: The most proactive tip I can give is to anticipate the time change by getting up and going to bed earlier, several days prior to an eastward trip and later for a westward trip. For example if there is a 5 hour difference between NYC and England, try going to bed 30 min earlier each day until there is ~1-2 hour differential between when you want to sleep at your destination and when you go to sleep at home. It’s a lot easier to shift your schedule back by 1-2 hours than it is 4+ hours.
• Properly using Melatonin: Melatonin is a powerful sleep aid, but only when used correctly. IT IS NOT A SLEEPING PILL. Against common wisdom, it does not in fact “create sleep” but rather primes your body to enter a state of restful wakefulness in anticipation of sleep. To ease jet lag take 1-4 mg of Melatonin approximately 2 hours before your desired bed time. You can start taking melatonin on your desired destination schedule several days before departure.

• Control your Light Exposure: Light is the most powerful stimulus for resetting your biological clock. Exposure to light before and after your flight is critical in determining the length of time it takes to synchronize to local time. If you do not have a sleep mask I highly recommend one. Waterhouse et al. (shamelessly taken from Wikipedia) came up with the following table regarding recommendations for avoiding / seeking light in order to overcome jet lag. Suffice to say that these recommendations boil down to trying to reinforce the new time zone to your SCN by avoiding sunrise and observing sun down. Many of you know that electronic devices are supposed to be avoided before sleep. This is due to the light suppressing mechanism of the SCN described above. Ironically you can use your electronic devices during the light seeking hours in order to help your jet lag!

• Fasting: The current understanding is that by restricting caloric intake, in conjunction with asynchronistic feeding, introduces a stress that disrupts the rhythmic expression of genes that follow your daily circadian rhythm. This allows a novel schedule to be more easily established following the cessation of the stress. Put simply you want to maintain a consistent blood sugar level (not eat), trying your best to avoid spikes in insulin levels (caused by eating) while in transport. By withholding expected physiological hormone responses from your peripheral cells, you are trying to “restart” your peripheral rhythm when you feed yourself again at your destination. In this way you try to let your body anticipate the next meal at your regular feeding interval but on destination time. Once at your destination adherence to a hypo-energetic meal plan is recommended. If you must eat during the transit flight, I recommend reading up on the “glycemic index” of various foods and choosing the ones that will minimize postprandial insulin levels.   
• Hydration: An important caveat to fasting is hydration! It is imperative that you stay hydrated at all times, as dehydration will cause realease of a hormone named Vasopressin that has been strongly linked to disturbances in the SCN and therefore your sleep schedule!
• Sleep deprivation: I will reiterate that it is much easier to resist sleep than create the desire to sleep.  To this end, controlled sleep deprivation can be used to confuse your body into conforming to destination sleeping hours! An example of this would be a 6 hour flight from NYC to England departing at 12:00 – 16:00 NYC time arriving anywhere between 0:00 – 04:00 England time. Rather than trying to sneak in a couple hours of sleep on the plane it is much more effective to keep awake until bedtime at your destination, thus leveraging your body’s already natural response to a prolonged day in order to quickly adjust your schedule.
• Exercise and basic sleep hygiene: Exercise is good for you! I’ll leave it at that because the association between exercise and general wellness has been covered ad nauseam everywhere else. For tips on general sleep hygiene refer to: https://sleepfoundation.org/sleep-topics/sleep-hygiene

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I hope you enjoyed reading this article as much as I did writing it.  Please tweet at me to let me know if you enjoyed it or have any feedback. If there is enough interest I will write a follow up article regarding “Diet in Relation to Optimal Cognitive Function”.