From the Guidelines
To manage nicotine toxicity and associated insomnia, the most effective treatment option is to use a combination of nicotine replacement therapy (NRT) or varenicline, and for insomnia, cognitive behavioral therapy for insomnia (CBT-I) or pharmacologic therapy with FDA-approved drugs such as benzodiazepines or nonbenzodiazepine hypnotics. The treatment of nicotine toxicity and insomnia requires a comprehensive approach that addresses both the physical and psychological aspects of nicotine withdrawal.
Treatment Options
- Nicotine Replacement Therapy (NRT): Combination NRT, which includes a nicotine patch plus short-acting NRT for cravings (lozenge/gum/inhaler/nasal spray), is a preferred primary therapy for nicotine toxicity 1.
- Varenicline: Varenicline is also a primary therapy option for nicotine toxicity, and it has been shown to be more effective than NRT or bupropion SR in some studies 1.
- Cognitive Behavioral Therapy for Insomnia (CBT-I): CBT-I is a multimodal cognitive behavioral therapy targeted specifically to insomnia, and it consists of a combination of cognitive therapy, behavioral interventions, and educational interventions 1.
- Pharmacologic Therapy: FDA-approved drugs such as benzodiazepines, nonbenzodiazepine hypnotics, and orexin receptor antagonists can be used to treat insomnia, but they should be used with caution and under the guidance of a healthcare provider 1.
Important Considerations
- Combination Therapy: Combination therapy with varenicline and bupropion may be more efficacious than varenicline alone as a second-line therapy option for smokers who have demonstrated an inadequate response to frontline nicotine patch treatment 1.
- Side Effects: Common side effects of nicotine replacement therapy and varenicline include vivid dreams, change in taste perception, thirst, insomnia, and irritability, and dose reductions may be required in some cases 1.
- Anxiety and Depressive Symptoms: Combination therapy with varenicline and bupropion may increase the risk of anxiety and depressive symptoms, and patients should be monitored closely for these side effects 1.
From the FDA Drug Label
If you get symptoms of nicotine overdose, such as nausea, vomiting, dizziness, weakness and rapid heartbeat Keep out of reach of children and pets. Used patches have enough nicotine to poison children and pets. If swallowed, get medical help or contact a Poison Control Center right away. if you have vivid dreams or other sleep disturbances remove this patch at bedtime
The treatment options for nicotine toxicity include getting medical help or contacting a Poison Control Center right away if symptoms occur. For insomnia associated with nicotine toxicity, the option is to remove the patch at bedtime if vivid dreams or other sleep disturbances occur. 2
From the Research
Treatment Options for Nicotine Toxicity and Associated Insomnia
- Exercise has been shown to mitigate sleep disturbances associated with acute nicotine withdrawal, specifically reducing the frequency of arousals and improving sleep maintenance 3.
- Antidepressants such as bupropion and nortriptyline have been found to aid long-term smoking cessation, with bupropion being less effective than varenicline 4.
- Nicotine replacement therapy (NRT) may not be effective in attenuating withdrawal-provoked sleep disturbances, and may even exacerbate sleep disruption 3, 5.
- Sleep changes during nicotine withdrawal can include increased arousal index, wake time, and sleep impairments, which may contribute to relapse into smoking behaviors 6.
- Nicotine consumption can lead to symptoms of insomnia, such as increased sleep latency, sleep fragmentation, and decreased slow wave sleep, as well as rapid eye movement (REM) sleep suppression 5.
Pharmacological Interventions
- Bupropion and nortriptyline have been found to be effective in aiding long-term smoking cessation, with similar efficacy to NRT 4.
- Selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs) have not been found to be effective in aiding smoking cessation 4.
- Varenicline has been found to be more effective than bupropion in aiding smoking cessation 4.
Non-Pharmacological Interventions
- Exercise has been shown to be a useful adjunct to smoking cessation treatment, specifically targeting sleep disturbances during early acute nicotine withdrawal 3.
- Behavioral therapies, such as cognitive-behavioral therapy (CBT), may also be effective in aiding smoking cessation and reducing sleep disturbances 7.