FAQ - Dealing with withdrawal symptoms
Question: It will soon be 5 months since I quit smoking. However, I find I still crave cigarettes. Is this normal?
Answer: The overpowering urge to smoke can occur several months after smoking cessation. In general, these cravings go away by themselves after 3-5 minutes. So it is best to wait and to use a distraction to help you deal with it (eat or drink something, walk around, etc.).
Question: I live with a smoker who gets extremely aggressive each time he tries to quit smoking, which he does every time he gets sick, this happens about every 5 months (acute bronchitis). How can medical science help him? Thank you
Answer of Dr. J.P. Humair, tobacco cessation specialist at Geneva State Hospital.
If your partner loses his composure when he stops smoking, it is for two reasons:
1. He is experiencing nicotine withdrawal which is making him irritable. The solution is for him to take nicotine, either in the form of patches or nicotine gum or lozenges, and gradually reduce the dose to enable him to stop smoking over a period of 2 to 3 months.
2. He didn't really decide to quit but, like the virus, it was forced on him unexpectedly. A planned quit attempt would be easier for him to accept and therefore would have a better chance of succeeding. Good luck, it isn't easy to live with a smoker who is trying to quit, but he needs your support!
Low spirits and depression
I. Question: I quit smoking on 1 January 2007...and since then I have had a feeling of uneasiness... it didn't appear straightaway but little by little over time... I have the impression that I spend my day worrying, as soon as I'm at home tears well up at any time and at night I suffer from insomnia... so at night I toss and turn, and I sleep during the day! What should I do? What can I take?
Answer: It is very probable that your symptoms are due to a depression that usually starts 1-2 months after quitting smoking. In most cases there is a spontaneously favorable evolution. However, you might need to seek the help of a health care professional and take medication for a short time. If your symptoms persist, I suggest you see your doctor. Good luck and carry on.
II. Question: I would like to know how long it takes until the worst (most unbearable) adverse reactions are passed.
I just finished my third week (as I gave in to temptation a few times at the beginning and smoked a few cigarettes I wondered if I had delayed the adverse effects) and I want to know when the obsession stops (or at least when it calms down), as well the great waves of the blues... As a mother of a large family with toddlers, I can't let myself go and give in to feeling depressed. I smoked intensively for 26 years (between 1½ and 4 packets a day) and my quit attempts never exceeded 2 days these last ten years, or a week when I was 16.
Answer: In general, physical withdrawal symptoms appear within 24 hours of quitting, are at their strongest 48-72 hours after quitting and are greatly relieved between 10-30 days depending on the level of dependence (for you that will mean at least 30 days!) and they disappear after 6-8 weeks. On the other hand every cigarette reactivates the dependency and then the withdrawal symptoms... Cravings triggered by situations in which the former smoker used to smoke decrease more slowly: in 6-12 months decreasing in frequency and intensity; but already after 1-2 months they are usually only ideas and are no longer cravings. However, this is a general trend and it varies greatly from person to person. Finally, all these symptoms can be considerably reduced by taking nicotine replacement therapy (NRT) or Zyban in adequate doses. Given the difficulty of withdrawal I would strongly suggest getting the help of a professional. In fact, these methods really increase your chance of success.
Insomnia, tiredness, lack of energy
I. Question: It's been a week since I stopped smoking. Since then, I wake up 1-2 hours earlier than usual. Could you tell me if this is related to nicotine withdrawal, and when these effects will fade?
Answer: Insomnia is typical of the problems caused by the lack of tobacco. All these disorders, including insomnia are lessened by NRT (patch, gum, etc.)... Insomnia may last several weeks after quitting smoking. NRT should be taken for 12 weeks after smoking cessation.
II. Question: I just quit (this is my third attempt), it was only four days ago and already my sleep is not the same, I fall asleep early, and about two o'clock in the morning I wake up. I already had the same problem on my first attempt, as I didn't want to take medication to regulate my sleep, I finally resumed smoking.
What encourages me greatly this time is that my sixteen-year-old son quit the same day as me; it is especially for him that I am making another attempt today. Are there any tricks for getting a good night's sleep?
Answer: When you quit smoking, one of the withdrawal symptoms is sleep disorder. This symptom can be reduced by using NRT. This will also facilitate your nicotine withdrawal. Ask your doctor or pharmacist. Congratulations on this attempt to quit with your 16-year-old son! It is crucial to find your own motivation to stop smoking.
I. Question: I would like to know how long the weight gain resulting from smoking cessation lasts. I have not really changed my eating habits (but I watch what I eat) and 1 month after quitting, I have put on 1 kg. Is this a bad start, or rather encouraging?
Answer: Weight gain after smoking cessation is progressive in the following months for a period of about a year. But weight gain is influenced by age, menopause, eating habits, physical activity, medications, etc. Smoking artificially lowers the weight of smokers by decreasing the appetite and speeding up metabolism, and the energy consumption. At cessation these two effects disappear and the ex-smoker returns to the normal weight of non-smokers of their age and sex, which is 3-4 kg higher. Some ex-smokers put on more weight and sometimes much more weight as they develop a compulsive eating habit, usually for sweet things, to replace their compulsion to smoke. NRT and Zyban reduce weight gain during the period when they are taken but do not prevent weight gain after treatment.
II. Question: I quit smoking on 8 January. I used to smoke 3 packs a day, but I've put on 12 kg and I'm still gaining weight. I don't eat candy, except sugar-free candy, and at noon I only eat vegetables, what should I do?
Answer: Congratulations on quitting smoking. As for weight, people usually put on around 4 kg when they quit smoking. They eat more at mealtimes, nibble between meals, and burn less energy (a cigarette burns between 8-10 calories). The best way to avoid weight gain is to find the balance between energy intake and expenditure.
I advise you to reconsider what you eat in a day: do you eat a lot during meals, do you eat things in between meals other than sugar-free candy, and do you eat too much in the evening as you don't eat starchy foods at lunchtime? The other question you should ask yourself is: do you do enough physical activity? Do more sport: at least 45 minutes 3 times a week and if that is not enough, get advice from a dietician, smoking cessation alone is not sufficient to explain this weight gain.
Nose, throat and breathing
I. Question: I would like to know how to protect myself from the discomfort caused by smoking cessation (back of the throat itchy, runny nose, irritated ear). It seems that during the first year we are more fragile. What can I do to be rid of these mini colds which are so tiring, without taking medicine?
Answer: You are correct in saying that for a few months the body "cleans itself" and it is more vulnerable to ear, nose and throat (ENT) infections. This happens for about 6 months. To be more precise, it is the disappearance of the anti-inflammatory effect of cigarette smoke, and the aggression of pollens, pollutants, etc. on mucosal inflammation which result in these irritating symptoms.
But do not worry; this period is over very quickly. To protect yourself:
1. Get rid of any viruses that may be on your hands when you get home or go to someone else's home. Wash your hands regularly with soap and dry them on disposable absorbent paper without touching the tap with clean hands to turn it off. If this is impossible at least make sure that the towel is clean. When you know that the flu virus can survive for three days on a plastic or metal surface, you understand why outbreaks are so rapid and widespread! When a friend is sick you can also wear a mask (or give them one), these can be bought in pharmacies. Not a FFP2 mask which is very expensive, but a simple one, that is enough. Don't hug and kiss people when you are sick, this stops viruses from spreading. Don't hug or kiss people who are sick either, they understand very well.
2. A diet which is rich in fruit and vegetables, regular sleep at night, clothing that is suitable to the temperature outside and being well hydrated all participate in a good immune system. To help stimulate your natural defenses even more there are specific "immune system" treatments based on zinc, copper, magnesium and vitamin C.
II. Question: I am 31 years old, I have been smoking for 16 years and it's been three days since I quit, and I'm really determined not to relapse this time. I very occasionally have asthma in reaction to certain allergies. However, since the morning I quit, three days ago, I've been surviving on Ventolin. I have asthma all the time. It's tiring, I'm breathless. I think this week I'll see a pulmonologist, but there are only three in my town and I fear they are on vacation. I'm a little worried... could this be due to quitting smoking abruptly (I smoked a pack a day and now I'm using a 21 mg patch a day)?
Answer: Among the additives to cigarettes there are substances that allow bronchial dilation. It is therefore possible that by stopping smoking you accentuate your asthma temporarily. It is also possible that smoking cessation leads to anxiety which manifests itself as difficulty in breathing which can be interpreted as asthma.
To understand what is happening, the pulmonologist is the specialist to go to, but if all the pulmonologists of the city are absent your family doctor or a general practitioner will also be able to treat you. He may temporarily increase your treatment for asthma, which will prevent you over using Ventolin.
Anyway, congratulations on your efforts. In addition to the 21 mg/24 hour patch you are using, you can also chew six 2 mg sticks of gum, for example, to relieve the cravings that are hard to ignore.
I. Question: I quit smoking about a week and a half ago. I used to smoke a cigarette when I went to the bathroom. The fact of not smoking when I go to the toilet is making me constipated.
Answer: As you have seen nicotine has a stimulating effect on intestinal transit and helps bowel movements and you have developed an automatism in this situation. Constipation is one of the symptoms that occur during nicotine withdrawal. This symptom will gradually decline during the first 1-2 months of quitting.
Meanwhile, as it is unpleasant, I suggest you put things right using a simple remedy such as eating tamarind jam or prunes that have soaked overnight, in the mornings. You should also make sure that you have an adequate intake of fluids - at least 1½ liters per day, and even more if you are doing sport. If that is still not enough you may need to consider taking a laxative, preferably a fiber-based one.
Good luck in your efforts, which will succeed if you can do without that cigarette to go to the toilet. If you keep the habit for a long time, there is a risk that you will increase your consumption bit by bit until you are smoking as many as you were before.
II. Question: It has been 3 weeks since I quit smoking and became a happy ex-smoker! There are a few lows, but a lot of great highs!!! I do have a problem since I stopped smoking though. I have a problem with my intestines; I often have pain and bloating which is not very pleasant and which coincides with my stopping smoking... Well to be honest, I already had a problem with my bowels, but not as much and above all it did not last as long. Could this be related?
Answer: Yes, it may be related because nicotine activates intestinal transit. Therefore stopping smoking slows down intestinal transit, which can manifest itself as bloating and constipation, which can both cause abdominal pain due to pressure on the intestinal wall. This gradually decreases with the disappearance of withdrawal symptoms in 1-2 months. Make sure that you drink enough and increase the fiber in your diet with fruit, salad, vegetables and whole grain cereals and move! A laxative is only needed in cases of severe constipation.
III. Question: It is now 8 months since I quit smoking, the first months I was very constipated and I had just recovered an almost normal transit by eating lots of vegetables and fruit. Now last week I had diverticulitis which must be operated on next month. The doctor told me that this is due to constipation and stress. Could stopping smoking have caused this?
Answer: Diverticulitis is not caused either by smoking or by quitting smoking and occurs in both smokers and non-smokers alike. On the other hand cessation may have caused constipation during the first months but not long enough cause the diverticula. Diverticulitis is an inflammation of diverticula (diverticulosis) of the large intestine which appear very frequently as people get older, this takes place over a number of years (not eight months). Constipation and a diet that is low in fiber could be contributory factors to the formation of these diverticula, but there are probably other causes that we do not know. We do not know what caused a sudden inflammation of a diverticulum (diverticulitis), just as we do not know what causes appendicitis. I doubt that we can attribute it to stress, which is a convenient scapegoat and is invoked every time the cause is unknown. I'm sure the doctor has no solid evidence that stress is the cause.