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The Effects of Physical Withdrawal

Anxiety, Anger, Irritability, Impatience and Restlessness,

The above are all normal temporary effects of physical withdrawal from nicotine. Our life long roller-coaster cycles of rising and falling blood nicotine levels are now ending. Our body is adjusting. If we remain 100% nicotine free for just 72 hours we'll begin to notice these effects begin to gradually diminish as our brain's neurons begin bathing in nicotine-free oxygen rich blood serum. Although our quickly healing body is now 100% nicotine free and most of the normal symptoms of adjustment have reached their peak, it will take 10 days to two weeks before our mind and body become fully accustomed to the absence of nicotine and many of the other 4,000+ chemicals present in each burning cigarette. The early healing is rapid. Deep breathing with mind relaxation, together with a bit of physical activity, can help diminish anxieties. Adjustment of caffeine intake and limiting sugars can also have a calming effect. Acidic fruit juices, like cranberry, may help accelerate extraction of the blood's remaining nicotine and decease the maximum of 72 hours required for the body to completely metabolize all nicotine.

There is a detailed cessation effects study by Marcia M. Ward, entitled "Self-reported abstinence effects in the first month after smoking cessation," published in Addictive Behaviors, 26 (2001) at pages 311-327. Its findings are fascinating. For example, it may be difficult to believe but, on average, anxieties peak on day one (within 24 hours) and within two weeks return almost to precessation levels. Regarding anxiety, be sure you understand why ex-smokers only need half the amount of caffeine as smokers (discussion link). Irritability, often anxiety's aftermath, seems to peak at about 48 hours while restlessness peaks at 72 hours. According to the study, both begin hovering back around precessation levels within two weeks.

Anger apparently peaks for the average quitter at about 48 hours (day 2) and within 72 hours is beginning to return to almost precessation levels. Find ways to vent your frustrations that won't cause needless hurt to family members, loved ones, friends or co-workers. Walk, run, vent into a pillow, find a punching bag, bend a piece of steel, or even bite your lip for the few hours (less than 72) that it will take before you begin to sense the onset of some relief. Talk about your feelings with family, friends or in your support group. Write yourself a loving letter to be read in a year from now that accurately describes what your chemical withdrawal and early psycholigical recovery experience was like and why you were more than willing to endure it. The mind does not remember pain or the bad times. In fact, you memories of "Glory Week" will rapidly fade within just a few short weeks. Give yourself the present gift of future memory. It may be just the motivation that you'll need to avoid temptation tomorrow.

Occupy your time. Try enjoying your favorite activity, sport or hobby. Celebrate each hour of freedom. Keep a positive attitude and review your reasons for beginning this journey. Clear your mind of all negative thoughts and chatter. Don't allow the seeds of false reasoning to fester and infect your logic or desire. Show yourself courage as you break free from years of slavery to the dictates of your master.

Inability to Concentrate or a Foggy Mind

The feeling that your concentration isn't as good or that your mind now lives in a fog is experienced by almost two-thirds of "starters" (recovery and starting a new life are much more positive thought than "quitting" and will be used throughout this article) to one degree or another. The return of your clearness of mind and concentration levels may seem gradual but within two weeks most begin experiencing concentration levels very close to those of neversmokers.

Poor concentration, focus and thought can also be associated with low blood sugar. It's important to understand that nicotine force fed us stored fats and sugars with each new puff. It's why so many of us could skip breakfast and/or lunch and not feel hungry. Smoking nicotine caused our brain to release adrenaline which in turn prepared us for the "fight or flight mode" by pumping stored fats and sugars into our blood stream (the bad artery clogging fats).

Once we stop putting nicotine into our body the adrenaline fat feedings end. If you continue to attempt skipping meals, your blood sugar will plummet along with your concentration. It isn't necessary to eat more food but only to spread your normal daily food intake out more evenly over your entire day. Women would be well advised to put a very small amout of fuel into their stomach about every three hours and men at least every five. During only the first 72 hours (as it can be fattening ) natural fruit juices (cranberry is excellent) will not only aid with helping stabilize blood sugar but may actually help accelerate the rate at which nicotine metabolizes just a wee bit. Here is a good discussion thread on the subject.

Even if you can't correct the entire problem by stabilizing blood sugar and you're forced to push yourself a bit more than normal in order to live up to your old expectations, concentration improvement appears to be fairly steady and relief won't be long in coming. You may also want to temporarily reduce or avoid alcohol use which reduces brain oxygen, and obviously impairs concentration. Brisk walks or other physical exercise and slow deep breathing will deliver additional focus giving oxygen to your mind. Remember, life giving oxygen is a far healthier brain stimulant than any addictive substance. Trust in you! It's only temporary.

Flash - a new medical study was released in May 2002 indicating that heavy nicotine use may actually destroy brain cells and diminish concentration and memory. Here is a BBC news link and a link to the study abstract. If true, the very temporary concentration effects associated with adjusting to the absence of nicotine might better be seen as a very welcome occurence!

Feeling Tired or Fatigued

Our body is shedding the effects of being under years of dependence upon a powerful stimulant and the process of withdrawal can be emotionally exhausting. We're also experiencing changes in our basic metabolism as our heart rate and respiration have rapidly returned to normal. It isn't unusual to feel a bit drained during the first few days but after that you should begin feeling much better with more energy than you may have felt in years!

Just as recovering from any other illness, the body and mind need time to heal. Moderate exercise can act as a natural pick-me-up and also help us sleep better. We need to allow ourselves additional rest, extended sleep or even a nap. "Glory Week" consumes tremendous energy.

It is not normal to continue feeling tired or fatigued three weeks after starting your journey and there are many potential causes ranging from improper diet, blood sugar problems, medications in need of possible adjustment after ending the use of the 4,000+ chemicals present in tobacco smoke (including nicotine), an underlying condition that was being masked and hidden by those same 4,000 chemicals, or by other coincidental conditions that just happened to occur and have nothing whatsoever to do with ending tobacco or nicotine use. Also, see depression below.

Trouble Sleeping or Insomnia

Nicotine is a powerful drug that affects subconscious thought, brain waves, the depth of sleep, and can even affect dreams. The disturbance of "normal" sleep patterns can occur during physical withdrawal or new patterns may be established as you return to your body's true level of need. You may find that you don't need nearly as much sleep as you did while smoking. Are you still tired or just sleeping less?

It's important to understand that nicotine smokers need twice the amount of caffeine in order to achieve the same effect as a non-smoker. Nicotine indirectly causes caffeine to metabolize (to be depleted) at a rate twice that of non-smokers. If you're a heavy caffeine user who attempts to continue using caffeine at the same amount as you did while using nicotine, you may find yourself not only having difficulty sleeping but probably climbing every wall in sight. Here's a Freedom message thread discussing the issue in far more depth.

Relaxation through mind clearing and slow deliberate breathing can help induce sleep. Mental relaxation can be as simple as slowly clearing your mind of all other thoughts by focusing exclusively on a single object or color. If your sleep continues to be disrupted and is affecting your health, safety or performance then turn to your physician or pharmacist for assistance. Don't allow sleep to be your mind's junkie excuse to destroy your quest to meet and become comfortable as "you" again.

Chest Tightness

Chest tightness is normal, temporary and should not last for more than a few days. Aside from arising from the tension and stress associated with early withdrawal, it can be a component of normal postpartum nicotine blues or be associated with the early cleansing, coughing and healing occurring within our lungs. Any tension or depression induced tightness or muscle stiffness may benefit form relaxation exercises, a warm shower, slow deliberate breathing or moderate exercise. Fluid or ice-water may help with minor discomfort associated with tar and mucus removal or irritation due to coughing. Keep in mind that your lungs need lots of moisture to help with healing and flushing. As a rule of thumb your fuild intake should equal a minimum of one-half your body weight in ounces daily. I now live with a glass of ice-water by my side. If we have any concerns about chest tightness, it never hurts to pick up the phone and give our doctor a call.

Slight Sore Throat

Years and years of smoking while ingesting hundreds and hundreds of chemicals (every twenty to thirty minutes) has irritated our throat, damaged or destroyed millions of cells, has deeply marinated tissues in gobs of tar, and has caused them to become numbed to the tremendous harm being inflicted. As our tissues begin to heal, they may feel temporarily irritated as the cells slowly renew, our tissues begin to breathe and natural moisture levels gradually return. Cool liquids and juices may provide a bit of soothing. Hard sugarless candy or cough-drops may also generate moisture, provide soothing or give relief from minor discomfort.

Coughing, Mucus or Nasal Drip

According to the Ward "abstinence effects: study, roughly 60% in recovery reported coughing on day two, 48% by day seven, 33% by day fourteen, and 15% by day twenty-eight. I hope that those still coughing after a month made an appointment to go for a thorough check-up! Our bronchial brushes or cilia are healing and again engaging in cleaning and clearing. Years of tar build-up is loosening itself and must either be expelled or flushed from the lungs. Mucus and coughing are common but as seen from the Ward study many in recovery often experience neither. If you do experience increased coughing that persists, it is highly advisable to see your physician for a complete checked-up as one of the earliest signs of lung cancer or disease is a chronic cough.

Clearly our lungs will benefit from extra fluids to aid with cleansing and healing. Although the 8 x 8 rule is under attack in some literature, many authorities still advocate trying to drink at least eight glasses of water daily. Try ice to sooth and moisten the mouth and possibly lemon for flavoring and a bit more valuable nicotine extracting acid. Cough syrups or decongestants can also bring some temporary relief from coughing or irritation but if your cough should persist don't hesistate to give your doctor a call. It isn't uncommon to see a smoker's lung function improve by almost a third within just 90 days. That's an amazing pace. I couldn't run 200 feet prior to quitting and truly thought I would never would again. Not too far but today these lungs can run like the wind and amazingly not be winded when I stop. I thought I'd damaged them beyond repair. I'm so glad I was wrong!

Bad breath or a nasty taste in your mouth

Not only will the terrible aroma of healing lungs as they exhale, cough and flush years of tar buildup touch your taste buds or sense of smell, our gums, cheeks and even our tobacco marinated tongue have been impregnated with years of chemical deposits. Depending on how long we smoked it could take some time for these tastes and odors to totally dissipate. Cell healing, time and fuilds will keep our lungs and tissues on the road to maximum recovery. Brushing our teeth more frequently and mouthwash should help control the odors that will continue to rise from our recovering tissues and lungs. As for your gums and possible over-brushing, it's not unusual for an ex-smoker's gums to be more prone to bleeding upon probing. Although the lungs of long term heavy smokers may take years to heal and fully cleanse, the odors and tastes will gradually improve with time.

Headaches

Changing brain oxygen and chemical levels, added anxiety or tension, possible temporary sleep disruption, increased caffeine levels, or diet changes can all result in headaches. According to the Ward "abstinence effects" study, 33% of smokers reported having headaches immediately PRIOR to quitting. Interestingly, those reporting headaches peaked on day three (72 hours) at 44%, dropped to 17% on day seven, and had declined to a low of just 11% on day fourteen.

Within eight hours of commencing recovery, carbon dioxide levels in our blood and brain return to normal but it takes time to adjust. Relaxation, slow deep breathing, extra rest, mind clearing with thought focusing exercises, a warm bath or shower, or exercise may help relieve tension and often brings relief. Aspirin or other headache relievers are available but shouldn't be taken on an empty stomach. If you are a fairly heavy caffeine drinker make sure you understand that ex-smokers only need half as much caffeine as smokers in order to get the same effect, otherwise your caffeine overdose may actually cause your headache. Here is a message board discussion covering the topic in far more detail.

Stomach Pain, Nausea, Constipation or Gas

Nausea was also examined in the Ward "abstinence effects" study. Again, although only averages, 16% of participants reported nausia on day one (as compared to 2% at precessation baseline), 11% on day three, 16% on day seven, 9% at two weeks, and 4% on day twenty-eight.

There are a host of digestive disorders, including cancers, associated with smoking. Intestinal and bowel movements can be temporarily affected while they adjust to the absence of nicotine. Stress, anxiety or postpartum nicotine depression can cause our stomach or GI area to generate pain. Tissues numbed and deadened by years of nicotine use are healing. It isn't uncommon to experience temporary pain. We can aid the healing process by drinking at least eight glasses of water each day. Increasing the amount of leafy vegetables, roughage, whole grains, bran or prunes in our diet will aid our intestines in cleansing and in moving things along. Moderate exercise may also help with circulation and movement. If symptoms persist, we need to consult our physician.

I normally tell people who experience wild or bizarre reactions the first few days not to be surprised or unduly alarmed, it is likely from not smoking. But at the same time they should not totally ignore certain symptoms, in case in the long shot that something else is happening just coincidently at the same time as they are quitting smoking. The symptom of muscle tightness is often felt through out the body. Back aches, neck pains such as those experienced from times of extreme stress, even leg cramps can be felt by some. Chest tightness too can be experienced. While quitting smoking is the usual reason behind the reaction, for obvious safety reasons it is prudent to get the symptoms checked with ones doctor. You just don't want to take the chance that you were the exception to the rule, that the chest pain was actually a signal of real heart trouble.

I have literally had over 4,500 people in smoking clinics over a 26 year time period and had only had two people actually have heart attacks within a week of quitting. And they were both people who were quitting because of doctors advice that a heart attack was an imminent danger because of pre-existing conditions. So while I am not trying to say that the risk of a heart attack is high from quitting, in fact your risk of heart attack decreases upon cessation and relatively quickly, there still is a risk as there is with all smokers, ex-smokers and even all never smokers. Ignoring a cardiac symptom is just an unnecessary risk that no one should take. It is better to check in with your doctor and to be safe than sorry. Doctors are often very receptive to work with a person when they are quitting for they often recognize the serious nature of the effort.

So as for symptoms, don't be surprised or alarmed by anything, but be cautious and stay aware. If you experience any symptom that would normally be a reason to get checked out immediately, follow through with the same expedience now. Life goes on without smoking and things can always happen.

Also, once over the first few days, be really cautious of blaming symptoms on smoking cessation. While some reactions can linger, especially coughing and excessive phlegm reactions, other factors can happen too, especially during cold and flu seasons. Pretty much stay aware and follow the normal precautions you followed before while smoking. Unless as a smoker you never did anything, for some smokers are intimidated to go to the doctor when having symptoms for shear embarrassment that the doctor would just chastise them for smoking and tell them to stop. Rather than putting up with the admonishments, they would ignore problems in the past.

As an ex-smoker you won't face the same complications. Again, doctors are often more prone to work with you when they see you working for yourself, and not to ignore symptoms writing them off to a normal smoker's ailments. They are often more supportive when you quit.

So to stay healthy, learn to listen to your body. Smokers are notoriously bad at this, for their body was likely telling them to quit for a long time and they ignored it. But the day the quit smoking was a good indication that they were now working with their body to maintain health. To keep a good partnership going with your doctor, other health professionals, your family, friends and your own body always remember to never take another puff!

Joel

I normally tell people who experience wild or bizarre reactions the first few days not to be surprised or unduly alarmed, it is likely from not smoking. But at the same time they should not totally ignore certain symptoms, in case in the long shot that something else is happening just coincidently at the same time as they are quitting smoking. The symptom of muscle tightness is often felt through out the body. Back aches, neck pains such as those experienced from times of extreme stress, even leg cramps can be felt by some. Chest tightness too can be experienced. While quitting smoking is the usual reason behind the reaction, for obvious safety reasons it is prudent to get the symptoms checked with ones doctor. You just don't want to take the chance that you were the exception to the rule, that the chest pain was actually a signal of real heart trouble.

I have literally had over 4,500 people in smoking clinics over a 26 year time period and had only had two people actually have heart attacks within a week of quitting. And they were both people who were quitting because of doctors advice that a heart attack was an imminent danger because of pre-existing conditions. So while I am not trying to say that the risk of a heart attack is high from quitting, in fact your risk of heart attack decreases upon cessation and relatively quickly, there still is a risk as there is with all smokers, ex-smokers and even all never smokers. Ignoring a cardiac symptom is just an unnecessary risk that no one should take. It is better to check in with your doctor and to be safe than sorry. Doctors are often very receptive to work with a person when they are quitting for they often recognize the serious nature of the effort.

So as for symptoms, don't be surprised or alarmed by anything, but be cautious and stay aware. If you experience any symptom that would normally be a reason to get checked out immediately, follow through with the same expedience now. Life goes on without smoking and things can always happen.

Also, once over the first few days, be really cautious of blaming symptoms on smoking cessation. While some reactions can linger, especially coughing and excessive phlegm reactions, other factors can happen too, especially during cold and flu seasons. Pretty much stay aware and follow the normal precautions you followed before while smoking. Unless as a smoker you never did anything, for some smokers are intimidated to go to the doctor when having symptoms for shear embarrassment that the doctor would just chastise them for smoking and tell them to stop. Rather than putting up with the admonishments, they would ignore problems in the past.

As an ex-smoker you won't face the same complications. Again, doctors are often more prone to work with you when they see you working for yourself, and not to ignore symptoms writing them off to a normal smoker's ailments. They are often more supportive when you quit.

So to stay healthy, learn to listen to your body. Smokers are notoriously bad at this, for their body was likely telling them to quit for a long time and they ignored it. But the day the quit smoking was a good indication that they were now working with their body to maintain health. To keep a good partnership going with your doctor, other health professionals, your family, friends and your own body always remember to never take another puff!

Joel