Our recommendation: go to a really good doctor who is well versed in the latest research.

Here is why.

First off, sleeping pills do not really work!

• On average sleeping pills reduce the time taken to fall asleep by less than 13 minutes!
• You only sleep 11 minutes longer than you would have without taking them.
• For many people the quality of sleep obtained using sleeping pills is not satisfactory.

Source: 2007 NIH Study, quoted in New York Times “Sleep drugs found only mildly effective, but wildly popular”

Next up: there are side-effects

• There are side-effects, which include memory loss, dizziness, reduced cognitive capacity, being dozy the day after use, and rebound insomnia.
• There are potentially dangerous interactions with other drugs, or alcohol.
• Traveller’s amnesia.  Some passengers who have taken sleeping pills to cope with jet lag have got lost or forgotten where they were!

Finally, they may kill you, even when used for only a short period

• Sleeping pill users have 3.6 times the risk of early death, even with fewer than 18 pills prescribed per year.  This also applies to new generation short-acting drugs like Eszopiclone, Zaleplon and Zolpidem.
• Up to 35% greater risk of cancer.

Source: Kripke DF, Langer RD, Kline LE. Hypnotics’ association with mortality or cancer: a matched cohort study. BMJ Open 2012;2:e000850. doi

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If you would like advice on a specific travel topic please request this via the comments.  While we cannot respond individually to requests, and the timing is entirely at our own discretion, we do try to respond to reader queries.  (If you want to ask something but do not want your comment published, say so in the comment and we will honour that.)

Skin care

This selection of skin products has a bias towards products that leave an oily residue on the skin.  My own preference is for products that are not very greasy.

• Tisserand hand cream.
• Elizabeth Arden Eight Hour Cream “to prevent my skin from drying up”.
• Massage oil.  (Grape seed oil is often used as a massage oil as it does not have a pungent smell).
• ESPA Botanical Rescue Intensive Balm, containing beeswax and essential oils – “it’s great for both my face and hands”.

The brutally scientific perspective on the use of creams for skin-care is that expensive brand-name creams have no statistical advantage over using plain cold-cream (which can have an oily residue) or aqueous cream.  That is a fact that could save you a lot of money.

Eye care

• Rosewater – “before landing I dip cotton wool pads in it and lay them on my eyes to avoid puffiness”.
• ESPA Floral SpaFresh facial spritzer “to wake me up before landing”.

Or you can just splash clean cold water on your face and eyes for the same effect.

Make-up

• Clarins make-up remover “as I don’t want to sleep with make-up on”.
• Clarins Beauty Flash Balm, “which you put on under your make-up when you arrive at your destination – it gives your skin a real glow so you don’t look jaded when you get off the plane”.

If you have other techniques that you have found to be effective then you are most welcome to share them with us.

Air quality

One’s first notion is to blame the air quality, because it is a cramped space.  The cabin air is without a doubt a significant cause of spreading germs on aircraft.  However, the aircraft manufacturers are aware of this risk and they have done three crafty things to reduce this source of germs and viruses:

1. They replace the air 20 times an hour, in comparison with an average office, where fresh air from outside replaces internal air just twelve times per hour.
2. The air is filtered with “high-efficiency” filters.
3. The air flow is not, as you might expect, from the front of the aircraft to the back, but it flows from ceiling to floor.

The result of the last factor means that if someone is diseased and sitting many rows from you, you are unlikely to breathe the air that contains their germs.  Unfortunately, it also means that if there is anyone within two rows of you with an illness, you are going to breathe the air that they have contaminated.  Again, and again, and again, and again.

The cabin air is typically as dry as a dessert, which also robs your body of some of its protective measures, and the stress of modern air travel also undermines your immune system.

You could ensure that you are getting all the vitamins your body needs, which many people find a help.  To hydrate your sinuses you could use a spray, but that smacks of eccentricity.  One might think that wear wearing a face-mask would protect you.  Not so, according to the British Health Protection Agency.  There is no objective evidence to suggest that they are a useful preventive measure.

If there is someone coughing or sneezing near you and there are empty seats on the plane, you could request that the cabin crew move you.

Lavatories

The aircraft lavatories may start out clean at the beginning of the flight, but by the time that dozens of people have used them, some with suspect personal hygiene, they become Contamination City.  Funny enough, unless someone has had an accident, the seat probably has fewer germs than your phone or your keyboard.  The danger areas are, perversely, the areas that you are most likely to touch: the door handle, lock, tap (faucet), washbasin, walls and the counter.

Never use water from the aircraft’s plumbing system for brushing your teeth.  As recently as 2004 the EPA found that, owing to faecal contamination, no aircraft water systems complied with the national drinking water regulations.  Owing to more stringent regulations this has improved, but on any day, a significant number of planes are carrying water that is unfit for human consumption.  Aircraft water systems need only be disinfected a minimum of four times a year.  Worse yet, if they find E. coli in the water, they can continue to operate the plane for up to 72 hours before restricting public access to the water.

Our suggestions:

• Use bottled water for brushing your teeth.
• Carry alcohol-based handwash and disinfect your hands after having used the lavatory facilities.
• Do not touch your face until after you have disinfected your hands.  Use moist towelettes to wash your face (either provided by the airline, or ones that you carry on board with you).

Your seat and space

According to the US government’s guidelines for cleaning and disinfecting aircraft possibly contaminated with influenza (http://www.flu.gov) the places that can carry infection and can infect subsequent travellers using the same seat are the following:

• Armrests
• The plastic/metal part of the seat back
• Tray tables
• Seat belt buckles
• Light and air controls, cabin crew call button and overhead compartment handles
• The adjacent walls, windows and window shades, and
• The individual video monitor.

With the quick turn-around of planes, particularly short-haul, it is unlikely that these surfaces have all been sterilised.  You can use antiseptic wipes to clean the surfaces yourself, but then you risk looking a bit over-the-top.  Perhaps a more discreet way to handle this would be to wipe just those surfaces that you will likely be in contact with whilst seated, and then use hand-disinfectant when you have had to touch the ventilation, lighting and other controls.

If you sit on an aisle then there is an additional risk you face – people with contaminated hands are likely to steady themselves on the corner of your headrest as they pass by.  If you are phobic about germs then you may do better to sit at the window.

If you need help with finding suitable disinfectants, the EPA maintains a list of approved sterilisers here: http://www.epa.gov/oppad001/chemregindex.htm  List G is probably a good place to start.

However scary this list may be, the simple fact is that few travellers contract any life-threatening ailment on board, and a few simple precautions can substantially reduce your risk of colds or flu.