Tips on Healthy Steps

Feeling lonely, angry, and even constipated are some of the unexpected side effects of nicotine withdrawal. Daniel F. Seidman, Ph.D., shares strategies for overcoming them in his book Smoke-Free in 30 Days.

I have worked with many hard-core smoking addicts, and more often than not, people are pleasantly surprised by how easy day one is for them. This doesn't mean they won't have their issues — like forgetting and absently going for a cigarette, or getting stirred up by one of their smoking triggers. But it does show that many smokers have an exaggerated expectation of the horror of withdrawal. Most of the time, especially with the proper use of NRT, it's just not that bad.

Nicotine Withdrawal Symptoms
Still, as you can see below, nicotine withdrawal does consist of a wide range of feelings and symptoms, many of which can make people feel emotionally raw and even like they are going through a mini-depression.

• Depressed mood
• Insomnia
• Irritability, frustration, or anger
• Anxiety
• Difficulty Concentrating
• Restlessness
• Decreased heart rate
• Increased appetite or weight gain

These symptoms illustrate how psychologically tumultuous a time nicotine withdrawal syndrome can be, and how important it is to be repared for the experience. For some people, learning to feel normal again without cigarettes is their biggest challenge. Remember that it takes time to get through tobacco withdrawal.

According to DSM-IV, the manual of the American Psychiatric Association: "Withdrawal symptoms can begin within a few hours of cessation, typically peak in 1-4 days, and last 3-4 weeks. Depressive symptoms" (after becoming smoke-free) "may be associated with a relapse to smoking."

Most people feel better over time, despite having their ups and downs; but if you feel worse depression and withdrawal over time, we strongly recommend contacting an appropriate health care professional. This will best help you safeguard your efforts to become smoke-free.

Cravings and What to Expect
Over time, cravings usually become further apart and less strong. They may spike, though, if you are experiencing one of your usual triggers, such as being upset, or if there is someone smoking nearby. Sometimes cravings go up for no apparent reason.

Usually around 3 weeks after a smoker quits, cravings start to feel more like thoughts about smoking. Thoughts about smoking aren't as urgent or pressured as cravings. Thoughts also don't usually provoke as much anxiety or concern as cravings. If your cravings don't let up, and you are using NRT, you may need to double-check your dose.

Remember that each cigarette has approximately 1 mg of nicotine, so make sure you plan your NRT accordingly. If you're a pack-a-day smoker, you need to get 20-mg worth of nicotine per day when you first start. Don't be in a hurry to taper off. You can taper off later, as you become comfortable and confident.

If you elected not to use NRT, and your cravings persist, this may be a good time to reconsider NRT. Some people experience prolonged withdrawal, which is defined as cravings getting worse, not better, over time and especially after 5 weeks of being smoke-free. If this happens, consult a specialist.

Symptoms of, and Solutions for, Nicotine Withdrawal and Cravings
If you've ever tried and failed to quit before, these symptoms will come as no surprise to you. But the physical and emotional effects of nicotine withdrawal can be surprisingly severe. Below, you'll find some ideas about how to address some of the more common issues ex-smokers face during their initial weeks of living smoke-free.

1. DEPRESSED MOOD
Even though you should be feeling great about quitting, it's not unusual for nicotine withdrawal to lead to feelings of depression. These feelings can sometimes be intense. Here are a few tips to keep in mind if you are suffering from a case of the blues after you quit. It's important to address this symptom since, if it persists and is left untreated, depression can trigger you to begin smoking again (among other unsavory side effects)

• Call a trusted friend who usually cheers you up.
• Write in your journal.
• Consider professional help.

2. INSOMNIA
Lack of sleep and depression go hand in hand. Insomnia is another important symptom of nicotine withdrawal that you need to address right away to keep yourself healthy and your resolution on track. Try a few of these behaviors to help keep your slumber patterns consistent.

• Do breathing and relation exercises for 20 minutes before going to bed.
• Avoid caffeine after noon.
• Exercise daily.

3. IRRITABILITY, FRUSTRATION, OR ANGER
No, it's not your imagination — nicotine withdrawal really does make you a little quicker to lose your cool. If you find yourself with a hair-trigger temper during your first smoke-free week, don't despair. These symptoms usually abate, and in the meantime try a few of these techniques.

• If your anger is directed at a specific person, write that person a letter. Decide later if it makes sense to send the letter. Sometimes just writing it is therapeutic!
• Do breathing and relaxation exercises.
• Count to 10, or take a walk to calm yourself.
• Engage in an enjoyable activity that is incompatible with being angry, such as watching a funny movie.

4. ANXIETY
When you're stressed, your old instinct was to grab a smoke. That cue-and-response automatic relationship has to change. Here are a few specific behaviors so you can start to substitute healthy habits for a negative one.

• Do breathing and relaxation exercises.
• Play some of your favorite calming music.
• Say the "serenity prayer" and remember that this too shall pass.
• Call a positive and helpful friend for support.
• Do some self-hypnossis.

5. DIFFICULTY CONCENTRATING
You may feel you're "in a fog" as your body detoxifies from smoking. Do not be reluctant to take it easy on yourself during your first smoke-free week. Give your mind and your body the time and priority they need to recover.

• Make a to-do list.
• Limit or decrease your commitments

6. RESTLESSNESS
Once your go-to cigarette is out of the picture, you may not know what to do with yourself or your hands. It's normal to feel a bit jumpy or restless during the initial quit period. Moving your body is a good way to address these symptoms. Take stock of your body in other ways and consciously notice your movements, large and small.

• Go out for daily walking.
• Continue daily deep-slow breathing and relaxation exercises.
• Stretch your arms and legs.

7. DECREASED HEART RATE
Some of the physical symptoms of nicotine withdrawal can be alarming. If you experience dizziness, fainting spells, shortness of breath, and chest discomfort, call a doctor.

8. INCREASED APPETITE AND WEIGHT GAIN
It's only natural to want to replace that cigarette with a doughnut. But the physical sensation of hunger is also a very real symptom of nicotine withdrawal. Don't be too worried about your weight at the beginning of your quitting period, but do try to address this with some basic behaviors that promote wellness.

• Avoid excess sugar and starches.
• Chew nicotine gum.
• Eat low-calorie snacks such as cut-up vegetables.
• Drink some water
• Exercise in a new way.

9. CRAVINGS
No matter how carefully you plan, it's normal to have some cravings for a cigarette as you're breaking free from smoking. You can be prepared for this. Be conscious of how your body feels and what actions you are taking to ride this out.

• Time the craving.
• Distract yourself with reading, music, or taking a walk.
• Try chewing a cinnamon stick
• Read over or remember your reasons for quitting

10. FEELING LONELY
For many people, smoking is not only a physical behavior — it's also a social one. Don't be surprised if you find yourself facing some tough emotions during your initial week of smoke-free living.

• Join a self-help group in person or online.
• Call a friend.
• Spend time with a pet or a child!
• Volunteer.

11. COUGHING
Smoking tobacco has coated your lungs in sticky tar. The good news is that as it begins leaving your body, your lungs will feel so much better. But the bad news is that in the short term, your smoker's cough will continue — and it may even get worse as your lungs clear up. Here are a few ideas to help alleviate some of these painful physical symptoms.

• Try a hot drink like tea with honey.
• Try sugarless cough drops.
• Call a doctor if your cough persists.

12. CONSTIPATION
Nicotine is a drug, after all, and you are in withdrawal from smoking it. Be sure to eat and drink properly to promote good overall health as your body detoxifies itself.

• Try over-the-counter remedies.
• Increase the fiber in your diet.
• Drink plenty of water.
• Call a doctor if your constipation persists.

13. HEADACHES
Take care of yourself, and treat your body right.

• Try over-the-counter remedies.
• Try a cold pack on your neck or forehead.
• Get a massage.
• Alternate heat and cold on your neck and forehead.
• Get some fresh air.
• Call a doctor if your headaches persist.