Hookah, also called shisha or waterpipe, is an apparatus used to smoke flavored tobacco by passing the smoke through a water basin before inhalation. This practice is often enjoyed in social settings and is associated with a feeling of relaxation, yet many users report a distinct feeling of tiredness or lethargy afterward. The primary reasons for this profound weariness are the body’s reaction to carbon monoxide inhalation, the biphasic effect of nicotine, and the cumulative impact of prolonged exposure.
Carbon Monoxide and Oxygen Deprivation
Post-hookah fatigue is largely caused by the inhalation of carbon monoxide (CO), a colorless, odorless gas. This gas is produced by the burning of charcoal used to heat the tobacco mixture, and it is inhaled along with the tobacco smoke. The water in the pipe does not effectively filter out this gas, leading to high levels entering the smoker’s system.
Once in the lungs, carbon monoxide rapidly enters the bloodstream where it competes with oxygen for binding sites on hemoglobin, the protein in red blood cells responsible for oxygen transport. Carbon monoxide has an affinity for hemoglobin that is over 200 times greater than that of oxygen. When CO binds to hemoglobin, it forms carboxyhemoglobin, effectively displacing oxygen and preventing its delivery to tissues and organs throughout the body.
This process results in a state of hypoxia, or oxygen deprivation, particularly affecting the brain and muscles. Symptoms of mild CO exposure include headache, dizziness, sleepiness, and fatigue, which are collectively known as “hookah sickness”. The feeling of profound tiredness is the body’s reaction to the reduced availability of oxygen needed for normal cellular function.
Nicotine’s Stimulant-Depressant Cycle
The shisha tobacco used in hookahs contains nicotine, which significantly contributes to the post-use crash. Nicotine acts as both a stimulant and a depressant, creating a dual effect on the central nervous system. Initially, upon inhalation, nicotine causes a temporary rush by stimulating the release of neurotransmitters like adrenaline and dopamine.
This initial surge increases heart rate and provides a brief feeling of alertness or pleasure (the stimulant phase). However, as the body rapidly metabolizes the nicotine, this stimulating effect wears off, leading to a subsequent “crash.” Nicotine also exhibits a depressant effect at higher doses, where the receptors become temporarily unresponsive.
The immediate drop in energy and the onset of lethargy results from the brain adapting to the initial high. This fluctuation from a stimulated state to a depressed one is a common mechanism behind the exhaustion reported after the session ends.
The Impact of Extended Smoking Duration
A typical hookah session lasts much longer than smoking a single cigarette, usually ranging from 30 to 60 minutes or more. This extended duration amplifies the physiological effects of carbon monoxide and nicotine exposure. During a 60-minute session, a user can inhale a volume of smoke 100 to 200 times greater than the smoke inhaled from a single cigarette.
Although the smoke is cooled by water, the prolonged exposure means the body continually takes in harmful compounds, including high levels of CO. This continuous intake leads to a much higher concentration of carboxyhemoglobin in the blood compared to a short smoking period, deepening the state of oxygen deprivation. The length of the session magnifies the stimulant-depressant cycle of nicotine, resulting in a more pronounced and persistent feeling of fatigue.
Reducing Post-Hookah Lethargy
Users who wish to mitigate the feeling of tiredness after a hookah session can take several practical steps to reduce the intensity of the chemical exposure.
- Ensure the smoking environment is well-ventilated, which helps to dissipate the carbon monoxide produced by the charcoal. Improving air flow can lower the concentration of inhaled CO, reducing the burden on the red blood cells.
- Maintain proper hydration by drinking water before and throughout the session, as dehydration can exacerbate feelings of light-headedness and fatigue.
- Consume a light snack to help stabilize blood sugar levels, preventing the nausea or dizziness that can accompany the nicotine crash.
- Limit the total duration of the session significantly to reduce the cumulative exposure to both carbon monoxide and nicotine, leading to a less severe post-use crash.