Smoking and sleeping go together like wine and milk, i.e., poorly. A varied body of evidence — polysomnography readings (sleep studies), feedback from smokers, human and animal biology studies — show that smokers combat disturbed sleep during each phase of their torrid affair with cigarettes. But solid rest tends to pose the biggest challenge during withdrawal.
Puff, Puff and I Can't Pass Out.
Based both on assessments of smokers’ sleep and objective recordings of their brain activity, it’s clear that nicotine consumption can take a toll on sleep — even before addiction forms. By acting on multiple brain chemical pathways, nicotine influences sleep and mood. But it’s not yet clear whether nicotine itself or short-term (overnight) withdrawal is primarily responsible for all the rocky rest.
According to a 2009 review of sleep-nicotine research, sleep troubles emerge both in non-smokers who’ve consumed small amounts of nicotine in a lab setting and smokers who measure time in minutes between smoke breaks. More specifically, nicotine consumption is linked to reduced deep sleep, suppressed REM sleep, trouble falling and staying asleep, fragmented sleep patterns and daytime sleepiness. And, according to large-scale population studies, smoking statistically predicts the development of sleeping issues down the road.
What Could Possibly Make Quitting Harder?
Indeed, all signs point to withdrawal as the most likely time for insomnia to become problematic. Somewhere between 40 and 50 percent of hopeful ex-smokers complain about chronic sleeplessness while trying to quit. Across varied studies, it’s demonstrated that the stronger the addiction, the harder it is to sleep during withdrawal.
Nicotine withdrawal is associated with higher rates of all the aforementioned sleep disturbances, as well as an uptick in nocturnal awakenings and higher rates of anxiety and depression. Again, it’s hard to pinpoint what exactly about withdrawal screws up sleep, largely because it may depend on the quitter in question. Other sleep-compromising issues, such as depression, are more likely to surface during withdrawal.
In fact, one recent study bemoaned the lack of cessation treatment regimens tailored to risk groups — particularly insomniacs and those suffering from mental disorders. Of course, there’s a two-way relationship at play: Withdrawal can make it harder to sleep, and sleeping poorly can make it harder to quit.
Can the patch help?
There are three main pharmacological treatments used for cessation: Nicotine Replacement Therapy (e.g, nicotine patches, gum, inhalants); the antidepressants bupropion/Wellbutrin; and varenicline/Chantix. This chart provides a good overview.
In some cases, smokers using cessation treatments report fewer sleeping issues than those going cold-turkey.
In “Quitters Never Sleep,” a paper published in the journal Current Drug Abuse Reviews, researchers wrote: “Little is known about the complex relationship between of nicotine-withdrawal related sleep difficulties, self-reported sleep duration and the subsequent use of pharmacological aids for sleep-related symptomatic relief during the nicotine withdrawal phase.”
The degree to which insomnia symptoms dissipate with the use of Nicotine Replacement Therapy varies considerably.
“Some studies have indicated that specific therapeutic nicotine substitution products that aid smoking cessation have positive effects on sleep,” says the same paper, “while others have noted that the true effect is often masked by withdrawal symptoms or suggest that these methods are largely ineffective in providing meaningful symptomatic relief.”
My doctor mentioned bupropion.
Bupropion is an antidepressant that doctors have prescribed off-label for cessation nearly as long as they’ve used it to lift moods. Smokers who take bupropion for cessation have about a 35 percent higher success rate than those who use Nicotine Replacement Therapy alone.
But, when it comes to sleep, bupropion is somewhat of a double-edged sword. Insomnia is one of the more frequent side effects associated with its use. Then again, insomnia and depression often go hand-in-hand, and some research suggests that underlying depression lies at the root of many sleep issues that emerge during withdrawal.
What about Chantix?
Right, Chantix. It’s still widely prescribed by doctors to help their patients quit, but this help may come at a price. Namely, bizarre, vivid dreams and unrestful sleep. Here’s a passage from a 2008 New York Magazine story on Chantix:
“By night four, my dreams began to take on characteristics of a David Cronenberg movie. Every time I’d drift off, I’d dream that an invisible, malevolent entity was emanating from my air conditioner, which seemed to be rattling even more than usual. I’d nap for twenty minutes or so before bolting awake with an involuntary gasp. I had the uneasy sense that I wasn’t alone…
The most unsettling thing about sleeping on Chantix is that I never felt like I was truly asleep. Some part of me remained on guard. It was more like lucid dreaming, what I thought it might feel like to be hypnotized. And it didn’t entirely go away come morning. As I showered, shaved, and scrambled into clothes, I tried to shake a weird, paranoid sense that I’d just been psychically raped by a household appliance.”
This Too Shall Pass
Smokers and ex-smokers who can’t log shuteye must realize their battle is more common than they realize. If this sounds like you, don’t hesitate to see a doctor. The good news: Proper sleep should eventually return. The tossing and turning that comes with both smoking and quitting typically tapers off, assuming you quit for good.