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Sleep vs. Blood Clots

Cindy Loose

The controvery about the true risk of so-called "economy class syndrome" -- potentially fatal blood clots forming as people are seated in confined spaces for long periods -- is over. A study by the World Health Organization found that the risk of blood clots is 1 in 6,000 for the general population during travel of more than four hours. This translates into one case for every 15 jumbo jets flying long distances.

Most travelers have heard they should regularly move their legs and walk about during long flights, and drink plenty of fluids, to avoid the syndrome, also called Deep Vein Thrombosis. This study merely reinforced that advice. The surprise advice: Reduce the risk of blood clots by avoiding sleeping pills.

It's important to know -- but then again, bad news for anyone like me who can't abide the notion of an international flight without the help of drugs and their ability to make you sleep sitting up in a tiny space, despite the snores of strangers.

Are you less likely to use sleeping pills based on this study? Or do you have any drug-free secrets for sleeping on long flights?

By Cindy Loose |  July 5, 2007; 12:20 PM ET  | Category:  Airline Industry , Cindy Loose
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A couple of years ago, I called my doctor's office for a sleeping pill prescription. I made it clear that it was only to manage a flight to Rome. The office attendant sounded shocked, and asked me if I wasn't worried that something could happen to the plane while I was asleep. What did she expect me to do? Flap my wings? Take over for the pilot? I got the prescription, and have used sleeping pills on overnight flights ever since. The pills dodn't put me to sleep, but they do let me sleep. If I had issues with my heart or blood, or if I slept more deeply with the pills than I do, I might consider not taking them. Until they become problems, bring on the drugs.

Posted by: Alice | July 5, 2007 12:56 PM

ear plugs and eye shades.

Posted by: me | July 5, 2007 4:17 PM

Well, this decides it. I'll save the Lunesta for dealing with jet lag after I get to Australia, and I'll make a run to CVS to pick up earplugs before departure.

Posted by: cotopaxi | July 5, 2007 8:10 PM

I find that Melatonin does the trick for me. And since it's a bit more natural, it somehow makes me feel like it's "okay". As Alice said, it doesn't put me to sleep, but certainly helps me to nod off.

Posted by: TXTrav | July 5, 2007 10:52 PM

I stopped sleeping on inter-continental flights a couple of years ago. Instead, on the trip out, I bone up on the language of the place I am going, and on the return, I read the latest anti-Bush book.

Posted by: FedUp1 | July 6, 2007 5:47 AM

It's pointless to try to sleep. I am still amazed at how the seats are designed to curve the opposite way of what would be comfortable: you end up hunched over and your neck pushed forward. I put the pillow under small of my back to try to even it out, but even so the seat pushes my head forward. Because I'm shorter, the headrests that have the little flaps - good invention - are not at right height. Neck pillows don't work that well. I also find it goes from too hot to too cold and someone is always shifting weight making the seat wiggle.

for transatlantic flights, the best plan is to get to destination a day early if possible or at least ask hotel to get an early check in so you can sleep a bit before trying to stay up the rest of the day.

Posted by: ACNonPro | July 6, 2007 6:14 AM

I started taking Valium (a muscle relaxer which possesses anxiolytic, anticonvulsant, sedative, skeletal muscle relaxant and amnestic properties) for long international flights over 20 years ago.

It allows me to essentially take a string of cat naps all during the flight. I'll watch a half hour of an in-flight film, then suddenly realize I've missed 20 minutes of it and so on. all the way across the Atlantic or Pacific.

TM

Posted by: Travellin' Man | July 6, 2007 6:53 AM

"Are you less likely to use sleeping pills based on this study? Or do you have any drug-free secrets for sleeping on long flights?"--- Well, what they actually said was "People also should not take sedatives or drink large amounts of alcohol because that would make them more likely to be immobile for long periods of time."--- it's not that the drugs, specifically, hurt you, it's the sleeping itself (and therefore not moving) that's the problem. So, "drug-free secrets to sleeping", if they actually work, wouldn't really decrease your blood-clot risk. What you want is a sleep-free secret to making a long flight tolerable.

Posted by: Anonymous | July 6, 2007 8:25 AM

One of the first times I flew in the states, I had very intense pressure in my ears when hovering at 15,ooo miles. The stewardess gave me two cups filled with hot moist towels. I placed the cups over my ears and that did the trick. Have not been able to get the stewardesses to do that since so I now use sudafed. This helps me to take cat naps during the flight. I have not had any ill effects from this treatment. And most importantly I no longer have the ear discomfort.

Posted by: Anonymous | July 6, 2007 9:29 AM

If you were truly "hovering at 15,ooo miles" I'm surprised you didn't have any worse problems than your ears. LOL!

Posted by: To 9:29 | July 6, 2007 9:45 AM

Being someone who has had blood clots at the early age of 19, and discovered she had a blood-clotting disorder, I would stay up the entire flight and move around. I wouldn't wish blood clots on my worst enemy, because they are life-threatening and incredibly painful. I would also suggest to frequent travelers to invest in some compression stockings, which work to keep the blood circulating while sitting. Find the better ones in medical supply stores - they can also fit you for custom stockings that fit better.

Posted by: kim | July 6, 2007 11:08 AM

So I do a lot of long trips, some in business, some in coach.
Various tricks for sleeping I use, plus some people have suggested
to me.

Noise cancelling headsets are great, as they really chop out the
noise -- but only if you find them comfortable to sleep in.
Otherwise ear plugs. If you can play soothing music that
sometimes help to sleep.

Neck pillows vary widely. The only ones I've found that work for
me are the inflatable ones -- you can adjust the inflation (I try to get it flat behind my neck, but with enough pressure on
each side that my head doesn't flop over and wake me up).

Accept that you will be jostled awake multiple times and
just focus on going back to sleep when it happens. You can't
prevent the interruptions, but you can ignore them.

I use meditation to go to sleep. Just focussing on clearing
my mind. Also, if your departure airport has a massage place,
get a back and shoulder massage -- helps relax you for the flight. (O'Hare, Minneapolis,
Washington Dulles, and Detroit all have good massage places).

Last, make sure your clothing works for sleeping. Comfy
shirt and pants -- I use running socks (the compression style)
to discourage swelling in my feet (which often happens after 4 or 5 hours in flight for me).

Posted by: million mile traveler | July 6, 2007 11:25 AM

After many years of long flights, I found the advice from million mile traveler on point: accept that you will be awakened, and don't get worked up when you are awakened. The killer in getting back to sleep (heavy doze in my case) is not to pay attention to whatever awakened me.

Bffore post 9/11 bottle-on-board restrictions, I found Odwalla Citrus C-Monster a terrific way to stay hydrated. Two bottles-- one frozen-- would get me cost-to-coast, and a few more for trans oceanic flights-- all frozen byut the first. On cross country flights, I "drank" the frozen bottle second as it turned into a slushy/slurpee. I miss that routine, and the TSA prohibition against taking beverages throughs security is frustrating.

Because I no longer can take my Citrus C Monster on board, I always buy a couple of over-priced bottles of water near the gate. I am surprised other posters haven't stressed the importance of drinking suffuicient liquids on long flights. And, BTW, another benefit of Odwalla C-Monster is that it does not create that acidic aftertaste or reaction that impacts some people after too much plain orange juice.

And: those exercises in the airline mags work! I always try any new ones, and I use a set of head-to-toe exercises to help me relax after takeoff.

Posted by: DC to West Coast Commuterer | July 6, 2007 1:07 PM

I fly often to Asia, and I'm amazed at how few passengers get up and move around. During the trans-Pacific leg of the flight I always stand back near the lavatories of galley at the rear of the plane at least once, doing a few simple stretches for 15 or 20 minutes. Apart from the physical benefits, it's a nice break and mental refresher. But often I'll be the only passenger back there.

To rest or sleep: noise-canceling earphones with ear plugs, eye mask, and mental relaxation techniques. With practice, the relaxation techniques alone are good enough.

However, to minimize the effects of jet lag, sleeping isn't always a good idea. The ideal is to be in sync with the local time at your destination. If you're scheduled to arrive in the evening or night, you really don't want to be well-rested.

Posted by: PF | July 6, 2007 1:09 PM

The poster who pointed out that the sleeping pills are not the problem is correct; sleeping itself is dangerous. This blog misses the entire point of the study, which is that prolonged immobility on a flight - and you are immobile while sleeping - raises the risks of blood clots. All this talk of melatonin, etc... is irrelevant. If you are worried about pulmonary embolism, you need to get up and walk around the plane every two hours or so. This is a not a pleasant prospect on a long flight, and it is certain to upset your seatmates unless you have an aisle seat.

Posted by: kaleberg | July 6, 2007 1:15 PM

I take the train. Lots of space to move about. Plenty of days to catch up on paper work and correspondence. Incomparable beauty.

Unfortunately, administrative hassles slow the trains down and make their schedules unreliable (every freight train has the right of way over every passenger train, except on the Eastern Seaboard).

Recently, urgent business required a plane trip cross country. I had forgotten what a truly unpleasant experience flying has become.

Posted by: Rachel Findley | July 6, 2007 3:12 PM

Kim @ 1108am and Kaleburg 115pm are on point. DVT clots are potentially fatal. I spent a week in hosp on thinners and self injected same thereafter.

See Victims of Air Related DVT. http://www.varda.org/

I skim stories also, but to repeat, this story is not about "how to sleep" it is about how to survive flight immobility.

Posted by: PaulSF | July 6, 2007 5:12 PM

On a recent transatlantic flight (US carrier) the flight steward requested that passengers NOT stand in the aisles or at the rear of the plane. Some passengers, including me, did it anyway to avoid sitting for long periods. But to request that people not move, I found amazingly ill-advised.

I will not be using that carrier again!

Posted by: Terry | July 7, 2007 12:11 AM

I am astounded that neither the article nor the comments mention one of the three most effective things one can do to prevent blood clots on long flights: take an aspirin! (Staying hydrated and getting up and moving around are the other effective actions.) Check with your doctor to make sure there are no reasons for you to avoid taking aspirin; if there are, you can discusss other "blood-thinning" substances, including natural ones, such as garlic or the type of "tree fungus" used in preparing ma-po tofu and other Chinese dishes.

Posted by: Roger | July 7, 2007 7:18 AM

Unrelated to the sleep problems but a funny sort of story. Myself and another crewmember were flying to London. Once we were airborne and all of the duties taken care of, I told my copilot he had the first leg of the flight and I was going to take a short nap. I eased my seat back a little and put my head against the window and fell right to sleep. After a small bump of turbulance I looked over at the copilot only to see him asleep. I stayed awake for the entire flight after that.

Posted by: hd | July 8, 2007 5:22 AM

I had a bipolar pulmonary embolisms from leg clots from my honeymoon to australia. If you are of northern European descent, you have a five percent chance of having the clotting disorder I have - Factor V Lieden deficiency. It makes me something like twenty times more likely to get a clot. Get tested if you ever have a pain in your leg after a long flight, and don't let them tell you it's pulled muscle - get the doppler test for blood clots.

Posted by: john | July 8, 2007 8:53 AM

As a specialist in the treatment of flight anxiety, I've found that people who are anxious about flying often turn to medication for relief. Medications do nothing more than take the edge off when taken as prescribed. This newly recognized risk suggests anxious fliers should look elsewhere for relief.

Effective ways of dealing with anxiety - and even panic - when flying can be found at my blog at http://www.fearofflyingblog.com

One simply and helpful method is called the 5-4-3-2-1 exercise. Focus on an object in front of you and say, "I see" and then name something in your peripheral vision. Say, "I see" and name something else in your peripheral vision. Continue until you have made five statements. For example: I see the lamp, I see the table, I see a spot on the lamp shade, I see a book on the table, I see a picture on the table.

Maintaining focus on the same object, say "I hear" and name something you hear. Then say "I hear" and name something else you hear. Continue until you have made five statements.

Then, say the words "I feel" and name something you are touching. For example: I feel the chair under me, I feel my arm against my leg, I feel my left foot on the floor, I feel my right foot on the floor, feel the shirt on my shoulder.

That completes one cycle. The exercise requires intense concentration. Concentration on non-threatening things leads to relaxation. Continue the exercise by starting a second cycle, but make one change: instead of doing five statements, do four statements. In the following cycle, do three statements. In the cycle after that, do two statements. In the final cycle, do one statement.

Captain Tom Bunn LCSW
email: tom@fearofflying.com

Posted by: Capt Tom Bunn LCSW | July 9, 2007 12:20 PM

I take one Tylenol P.M. on flights over six hours. I do not sleep but find I can doze in a very relaxed manner yet remain alert enough to move if need be. Upon landing I am rested and alert. In addition, Tylenol P.M. is non-habit forming and easy to carry through security.

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