The Health Compass
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Hot tips
on healthy eating and weight loss
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Hot tips on quitting smoking Ideas and innovations for health The author Contact Time planner Find your nearest retailer Quotations |
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The Health Compass hot tips on quitting smoking
● How to recognise nicotine withdrawal symptoms
● How to choose the right nicotine replacement product for your quit attempt
For more information on smoking and how to quit for life, take a look at The Health Compass book |
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How to recognise nicotine withdrawal symptoms
What is a withdrawal symptom
When you inhale the smoke from a cigarette, you absorb nicotine into your blood stream. Nicotine is responsible for the pleasurable feeling produced by smoking but it is also responsible for the need to smoke. That is, it is addictive.
If the body cannot obtain nicotine you experience withdrawal effects. Have a look below for some examples.
Craving
Cravings or the intense desire to smoke are experienced frequently in the first few weeks of quitting. They usually last for about 3-5 minutes before abating and reduce in their frequency after about 3 weeks. However they can come sporadically for several months after a quit attempt. Using Nicotine replacement therapy (NRT) or one of the newer medications buproprion (Zyban) or varenicline (Champix) can help. See the Health Compass book for information on these products and for more ideas to help with cravings.
Increased Appetite
Nicotine is an appetite suppressant and also causes an increase in the body’s metabolism which helps keep your weight down while you are smoking. When quitting, this is reversed so that it is possible to eat the same amount and yet to put on weight. Added to this many ex smokers replace the “hand to mouth” action of smoking with that of eating. Food also smells and tastes better.
Even if you do put on weight, giving up smoking is still the single most beneficial thing that you can ever do for your health. Some people find it easier to pre-plan and tackle their weight as they start their quit attempt; others prefer to wait and start only after they have been successful in stopping smoking.
See the Health Compass book for some great ideas on weight loss, eating and snacking healthily and increasing your exercise level in a fun and interesting way.
Tearfulness, anxiety, irritability and loss of concentration
The physical effects of nicotine withdrawal such as cravings and insomnia can be stressful. Also when breaking a long established pattern, sometimes of many years, there maybe a mini “grief reaction,” which can produce these symptoms. This can take a few months to adjust to. It is important under these circumstances to stay focussed on the positive reasons for which you decided to quit (see The Health Compass book for help in how to identify your reasons for quitting) and to remind yourself of how you will benefit both in health and other terms (see the Health Compass book on “reward”).
Sleep disturbance
Nicotine increases the metabolic rate and improves concentration. In the first week after quitting, withdrawal can cause the reversal of this and can lead to sleepiness. After a couple of weeks, some people find the reverse and have trouble sleeping. This usually settles after a further week or two.
Cough
Stopping smoking reduces your risk of developing lung disease. However some people find that initially on stopping smoking that their cough worsens. This is a result of the tiny hairs that line the lungs working more efficiently and getting rid of all the waste produced as a result of smoking.
This usually settles in a few weeks.
Light headedness
This is a result of the carbon monoxide (a chemical inhaled in cigarette smoke) leaving the body. This enables more oxygen to be carried in the blood which can produce a feeling of dizziness. It usually settles after 48-72 hours.
Tingling sensations
Nicotine causes the arteries in the hands and feet to constrict. Tingling is simply a sign of the circulation improving.
Constipation
Nicotine has a laxative effect on the bowels. This is a reversal of that and settles after about 2 weeks
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Hot tips on choosing the right Nicotine Replacement Product for your quit attempt
Why use NRT
Nicotine Replacement Therapy (NRT) has been shown to double the success rate in smokers trying to quit. When you inhale the smoke from a cigarette, it is the nicotine in the smoke that produces the pleasurable feelings in you but it is also this that is highly addictive and responsible for the difficulty with quitting that most smokers experience. Some alcoholics and heroin addicts have said that quitting smoking was far more difficult than quitting their other addictions.
NRT will allow you to break the behavioural addiction to smoking while satisfying your cravings for nicotine. It avoids you inhaling the 4,000 chemicals present in cigarette smoke of which are included cyanide and arsenic.
NRT is used for a limited time (3-9 months) over which period it is gradually withdrawn.
It is advised not to smoke while using NRT as side effects may be more pronounced.
Choosing the product best suited to you will make a big difference to your success.
Assess your level of dependency
The Fagerstrom test (see the Health Compass book) is a good way of assessing how dependent you are on nicotine. How many cigarettes a day you smoke will also give a guide to your nicotine dependence (over 20 a day habit would probably make you highly nicotine dependent). The two however do not always correspond. Occasionally a 40 a day smoker gives up with no bother whilst a 10 a day smoker finds it really hard to kick those last 5 cigarettes.
It is therefore not only important to look at your dependence but also at your habit (see Hot tips on kicking the habit cigarette and also the section on Safety Netting in The Health Compass book)
There are several different NRT products on the market and it can be very confusing as to which to choose. Currently available are nicotine:
● gum ● patch ● inhalator ● microtab ● lozenge ● nasal spray |
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Is there anyone who can’t use NRT?
It is now possible to use NRT when you are pregnant or breastfeeding and it can be used in children of 12 and over.
If you are pregnant it is better not to use the patch, however if you do use it (for instance if you are unable to use oral products due to nausea or vomiting), make sure that you use the 16 hour, not the 24 hour patch.
If you are breast feeding avoid the patch and use your NRT after breast feeding and never just before.
Nicotine can interact with some medications such as insulin, theophylline, propranolol, caffeine, imipramine, oxazepam and pentazocaine, so it is important to check with your doctor before you start.
Diabetics may need to monitor their sugars more closely when using NRT.
Patients with peptic ulcer disease, poorly controlled heart disease or blood pressure should consult with their doctor before starting NRT.
Patients with severe liver or kidney disease may have difficulty metabolising the nicotine with an increase in side effects.
Are there any products that I can use to help me reduce the amount I smoke, without actually stopping completely?
It is better to stop smoking fully when using NRT as side effects may be more pronounced if smoking while using it. However if you are not able to set a quit date to stop fully but prefer to cut down to stop, the products that are licensed for this are Nicorette 2mg gum, Nicorette 4mg gum, the Nicorette inhalator and the Niquitin lozenge.
Can I use more than one product at once?
Yes, those with a heavy dependency find that using the patch for a “background” dose of nicotine throughout the day in combination with one of the intermittent NRT products to use for breakthrough cravings helpful.
Where can I get NRT
All good pharmacies sell NRT and it can also be obtained on prescription through your doctor and through some quit smoking advisors. |
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Suitable for those who:
Unsuitable for those who
Pros: easy to regulate and may help stop you over eating
Cons: difficult with dentures
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Suitable for those who:
Unsuitable for those who: Have sensitive skin, skin allergies or a widespread dermatological condition
Pros: automatic background dose nicotine
Cons: insomnia and possible skin reactions
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Suitable for those who:
Unsuitable for those who:
Pros: good for hand to mouth action and helps prevent over eating Cons: embarrassment of use in public. Not good for heavy nicotine dependency |
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Nicotine Sublingual Tablet (Microtab)
Suitable for those who:
Pros: discrete. Easy dosing and few side effects
Cons: need to use correctly-useless if swallowed
Click here to read more about the sublingual tablet
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Suitable for those who:
Pros: Discrete. Variety of flavours
Cons: throat irritation/indigestion
Click here to read more about the lozenge
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Suitable for those who:
Unsuitable for those who:
Pros: Fast relief of symptoms
Cons: Nasal irritation and eye watering may be a problem and you are more likely to become ………dependent on this product. Ask advice form your GP
Click here to read more about the nasal spray
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How does it work?
Chewing nicotine gum releases nicotine into the mouth, where it is absorbed through the mouth’s lining after about 20-30 minutes of chewing. The act of chewing also helps distract the body from the craving.
The gum can be chewed regularly to help prevent the cravings due to nicotine withdrawal. Alternatively it can be chewed in response to a craving, as and when needed.
How to use Nicotine gum
The digestive juices in the stomach destroy the nicotine and too much nicotine in the stomach can cause hiccups and indigestion, so it is really important to use your gum properly.
Chew your gum slowly until the taste becomes strong, then park the gum between your gum and the lining of your mouth. When the taste fades, slowly chew again until the taste returns. Chewing and resting over a period of 30 minutes in this way should allow all the nicotine to be released.
Avoid soft drinks for 15 minutes before and after chewing as they can interfere with the gums absorption.
What dose?
The gum comes in 2 strengths, 2mg and 4mg. Those highly dependent on nicotine or smoking more than 20/day should use the higher strength and those with a lower dependency or smoking less than 20/day should use the 2mg dose.
You should chew between 8-12 pieces of gum a day and should not exceed the recommended number of pieces. This can vary according to the brand and so it is important to read the dosage and instructions of your particular brand before starting.
You should only chew 1 piece at a time and should not chew pieces in quick succession.
How do I reduce the dose?
After about 3 months it should be possible to reduce the dosage. You can do this by:
Are there any side effects?
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The patch delivers a slow stream of nicotine to the body through the skin. It does not give the peaks of nicotine seen with smoking but nicotine levels are usually enough to take away the significant cravings. It comes in 2 forms, the 24 hour and the 16 hour patch.
Which patch should I choose?
The 24 hour patch is better for those who are more highly dependent, or those who smoke more than 20/day or light up within the first 20 minutes after waking.
For those who are less dependent or who are pregnant the 16 hour patch is preferable, although it is preferable that if pregnant that you use an intermittent form of NRT.
The 24 hour patch tends to give more problems with skin irritation (although it is recommended that the site you use is rotated and local irritation usually resolves within a few hours of changing the site of the patch). The 24 hour patch may cause insomnia.
How should I use it?
The self adhesive patch is attached to dry hairless skin or the upper arm or thigh rotating the site and avoiding application of cream or powder to the area prior to use or application over irritated or broken skin.
The 16 hour patch should be removed at night.
One patch only should be used at once, although another form of NRT maybe used in conjunction during severe cravings.
You should not smoke whilst using the patch.
After use the patch should be removed and folded in half with the adhesive surfaces together and thrown away. Keep the patch away from children.
How should I reduce it?
The 16 hour patch is available in 3 strengths, 5mg, 10mg and 15mg.
For smokers of greater than10/day the regime should be as follows:
For smokers of less than10/day the regime should be as follows
There are 2 types of 24 hour patch, with doses of 5mg, 10mg and 15mg or 7mg, 14mg and 21mg.
The reduction guide for the 24 hour patch is as follows:
Are there any side effects?
Some experience skin irritation at the site of the patch. This can be minimised by rotating the site of application.
Headache, dizziness and sleep disturbances if experienced are usually transient and are possibly effect of nicotine withdrawal.
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Nicotine inhalator
How does it work?
The inhalator comprises a mouth piece attached to a replaceable cartridge which contains nicotine. Inhalation of air through the cartridge draws nicotine into the mouth and lungs. The nicotine is absorbed mainly through the lining of the mouth and so it is not important to inhale.
The inhalator is the only form of NRT which directly helps with the behavioural “hand to mouth” addiction.
How should I use it?
Use 6-12 cartridges a day. Each cartridge provides about 20 minutes of nicotine. This does not have to be used all at once and can be divided up into more frequent shorter periods of use.
The inhalator works best at room temperature. Used below temperatures of 15°C it will not function as efficiently.
The empty mouth piece should be cleaned by rinsing in water several times a week.
How do I reduce it?
The inhalator should be used over a period of 3 months as follows:
Are there any side effects?
Side effects if any are usually mild and transient and settle within a few days. You could experience, hiccups, indigestion, heartburn, nausea, headache, sinusitis, sore mouth, sleep disturbance.
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The sublingual tablet (microtab)
How does it work?
The nicotine is absorbed through the lining of the mouth. The tablet is placed under the tongue where it dissolves over a period of about 30 minutes.
How should I use it?
Place 1-2 tablets under the tongue when you have the urge to smoke or take regularly to prevent the onset of cravings. Smokers of 20/day or less or those with a low nicotine dependency should use 1 tablet and those who smoke more than 20/day or who have a high nicotine dependency should use 2 tablets.
Most smokers require 8-12 tablets a day. The number of tablets a day should not exceed 40.
Wait for the tablet to dissolve. The tablet should not be chewed, sucked or swallowed as the stomach digestive juices destroy the effect of the nicotine.
How do I reduce it?
You should have 3 months at 1-2 tablets an hour, gradually reducing to stop over the next 2 weeks.
Are there any side effects?
Side effects are usually short lived and mild and settle within a few days. You may experience nausea, indigestion, heartburn, hiccups, peppery taste in the mouth, headache, cough and insomnia.
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How does it work?
The lozenge is sucked and the nicotine is absorbed through the lining of the mouth.
How should I use it?
Suck a lozenge when you have the urge to smoke or regularly through the day to prevent cravings (every 1-2 hours). It should be sucked until the taste becomes strong and then rested between the gum and cheek. When the taste fades this should be repeated until the lozenge has dissolved (usually about 30 minutes)
The lozenge comes in 2 brands each with 2 doses. For smokers of 30 a day or less the lower dose lozenge should be used and of more than 30 a day the higher dose.
The usual dose is 8-12 lozenges a day.
Do not use soft drinks for 15 minutes before of after taking a lozenge.
How should I reduce it?
Start with a 3 month period of dosing at 1-2 tablets every hour. After 3 months on the full dose, gradually reduce the dose over the following 3 months. Treatment should not extend beyond 6 months in total.
Are there any side effects?
Side effects are usually short lived and mild and settle within a few days. You may experience nausea, indigestion, heartburn, increased salivation, hiccups, headache, insomnia, cough and insomnia.
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How does it work?
The nicotine solution comes in a small bottle fitted with a nozzle for insertion into the nose. The nicotine solution is sprayed up the nostrils and the solution is absorbed through the lining of the nose. This produces rapid delivery of the nicotine and is good for fast acting relief of symptoms as it takes effect within 5-10 minutes of dosage. This method is good for those highly dependent on nicotine.
How should I use it?
The bottle should be primed before use by pressing the bottom several times until a fine spray appears at the nozzle. The head should be tilted backwards and the nozzle placed up the nostril at an angle aiming to the back of the nose and not directly upwards. The bottom of the bottle should be pressed firmly and quickly to administer the dose. A spray into each nostril is one dose.
1-2 doses should be used per hour. No more than 2 doses per hour or 64 sprays per day should be used.
How should I reduce it?
Reduction regime for the nasal spray should be as follows:
Are there any side effects?
These include watering of the nose and eyes and sneezing or throat irritation, palpitations, nausea, sweating, headache, dizziness and sleep disturbance.
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How to kick the habit cigarette
Smoking for most people is a habitual ritual which involves a repeated pattern of behaviour, many times a day, sometimes over a period of many years.
When we perform an activity our brains make associations with many things, sometimes without us even knowing it. For instance, if you always have a cigarette after finishing your meal in the evening, your brain may also make an association with not only the meal but also the cup of coffee that you drink at the time and the place that you sit at the table.
How can I kick the habit?
Breaking the pattern by changing your routine in as many ways as possible makes it far easier to “unlearn” this behaviour. The change disassociates you from your triggers and therefore your habit.
Changing habits can be done in different ways. It can be by changing lots of little things like sitting at a different place at the table, changing your after meal drink to juice rather than coffee, eating at a different time in a different room, taking a different route to work, or walking rather than driving to avoid the association of the cigarette smoked in the car.
It could also be achieved by changing bigger things like moving all your living room furniture around so that not only is the furniture in a different place, but you are too; spring cleaning your house, washing your curtains and cleaning the carpets so that the incentive is there not to “dirty” it with smoke, or taking it one step further and repainting the house, as the financial investment makes a good incentive not to spoil the freshness of the new paintwork. Go to the dental hygienist and get the smoking stains removed from your teeth.
Changes of routine can help in other ways, for instance if you decide to avoid the pub for a while as the association with an alcoholic drink is strong, you could go for a walk or to the gym instead. Not only will you be saving money but also helping to keep the weight off by avoiding the calories of an alcoholic drink and by performing an activity.
If you decide to make a change to your diet (even the type of food that you have at a meal can act as a trigger, especially if you have a set routine for meals, for example steak on a Saturday), substituting a healthier option for one or two meals a week could help with preventing any weight gain.
Be creative with what you do. Involve the family if you have one, especially if you have children that are keen for you not to smoke, as not only will this be good bonding time but you will find them really supportive. Think about what changes you will make before you quit, so that you are ready with a plan on your quit date.
It takes about 40 days to “learn” a behaviour and the same amount of time to unlearn it. Changing your routine for at least that amount of time makes bad habits much easier to break as you remove the triggers for that behaviour.
REMEMBER THINK POSITIVE AND SAY TO YOURSELF REGULARLY “I AM A NON SMOKER” |
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Here are a few ideas:
The early morning cigarette
Change your routine
The mid morning cigarette
Change your routine
The telephone cigarette
Change your routine
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The cigarette at times of stress
The cigarette at work
Change your routine
The cigarette after work
Change your routine
The cigarette after supper
Change your routine
The boredom cigarette
For lots more ideas and information about how to quit smoking, see the Health Compass book |
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The reward cigarette
You deserve it |
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Even if you don’t inhale, cigar smoke is toxic to the body. You can still get smokers lung and cancer of the mouth throat and oesophagus.
The toxins in the smoke dissolve in the saliva and can cause stomach ulcers
Cigarette smoke contains 30 times the amount of carbon monoxide than a normal cigarette. Carbon monoxide binds to the red blood cells and “crowds out” their ability to carry oxygen. It contains a higher concentration of nicotine, benzene, hydrogen cyanide, lead nitrogen oxides and ammonia than do cigarettes.
The smoke from an average cigar is equivalent to that of 3-5 cigarettes in terms of passive smoking
For more ideas and information on how to quit smoking for life have a look at The Health Compass book
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