Dr explains: Why smoking after a sleepless night is more dangerous than you think

Smoking remains one of the leading preventable causes of cancer worldwide, linked to at least 14 different types including lung, laryngeal, pharyngeal, bladder and esophageal cancers.

Studies published in The Lancet also highlight how tobacco-related carcinogens trigger specific genetic mutations, particularly in TP53 and KRAS genes, accelerating cancer development. Emerging research shows that even occasional smoking, vaping or exposure to second-hand smoke can cause measurable harm.

Compounding the risk, chronic sleep deprivation weakens immune function, impairs DNA repair and increases systemic inflammation, creating a biological environment in which smoking can inflict even greater genetic damage.

Firstpost spoke to Dr. Vivek Shetty, Senior Consultant and Head & Neck Oncology at SPARSH Hospital (Bangalore) to shed light on the early warning signs of voice and throat damage from smoking, the reversibility of these changes and how poor sleep further magnifies the risks.

More from Health

What are intra-articular loose bodies and why they threaten knee health Genes or junk food? How metabolic obesity silently threatens health in India

Excerpts:

What are the early signs of throat or voice damage from smoking, and how reversible are they after quitting?

Dr Shetty: A single cigarette exposes the vocal cords and larynx to hot smoke and some of the chemicals like formaldehyde and acrolein. These irritants also cause dehydration of the mucosal lining leading to dryness and swelling. The cilia which clear the mucus becomes paralyzed that allows irritant to linger and inflame the tissues. This can also trigger temporary changes in voice and hoarseness. One tine exposure usually causes reversible effects and repeated exposure lowers the threshold for injury. Persistent irritation also remodels vocal cord issue making swelling and changes in voice more long lasting especially when smoking becomes habit.

How long does it take for throat health to recover after quitting smoking, and are some damages permanent?

Dr Shetty: Early warning signs include hoarseness, vocal fatigue, dryness, frequent throat clearing, and a persistent “scratchy” sensation. Occasional smokers may notice that their voice becoming rough or weaker after the use. If someone quits hoarseness, vocal fatigue, dryness, frequent throat clearing, and a persistent “scratchy” sensation. Most reversible change gets resolve in 6-12 months especially in the young individuals. However, if smoking has caused scarring (Reinke’s edema), polyps, or leukoplakia, recovery may be incomplete. Some of the advanced changes like stiffness of vocal cord or malignant transformation cannot be resolved simply by quitting.

Does vaping or e-cigarette use also harm the throat and voice? Is it really a safer alternative to smoking?

Dr Shetty: Vaping usually avoids combustion but still delivers nicotine, flavouring agents, and solvents such as propylene glycol, which are irritants. This can also dehydrate the vocal folds, trigger the inflammation and cause infection in throat. Current evidence reflects that the risk of severe laryngeal damage is quite lower than the cigarettes but safer does not mean that it is completely safe. Vaping can still impair the quality of voice and cause the chronic throat discomfort. Some of the chemicals in vape aerosols may form the toxic aldehydes at high heat. Overall, any type of chemical which is inhaled whether it is cigarette, smoke, vapour or hookah poses risk to delicate the tissues of vocal cord and no truly alternative of the same exist.

How exactly does smoking cause genetic mutations and which cancers beyond lung cancer are strongly linked to tobacco use?

Dr Shetty: Tobacco smoke contains carcinogens like benzopyrene and nitrosamines which get bind to DNA and also cause mutations. Smoking is very associated with “mutation signatures” mainly found in TP53 and KRAS genes, which drive the growth of cancer. Beyond the lungs cancer smoking also improves the risk of cancers of larynx, pharynx, esophagus, stomach, pancreas, kidney, bladder, cervix, and even some leukemias. Epidemiological evidence is the strongest for the cancer related to neck, head and bladder where upto half of the cases are related to tobacco. Continuous rise in trends also shows links to colorectal and breast cancers. This genetic injury from smoking is cumulative and permanent once the mutations occur.

What happens when smoking is combined with sleep deprivation? Do the risks compound in terms of DNA damage and cancer?

Dr Shetty: Lack of sleep weakens the functioning of immune reduces the efficiency of DNA repair, and heightens the systematic inflammation as well. When smoking is added, carcinogens and oxidants cause even more DNA damage with fewer cellular defences available to repair it. This compounding effect can also accelerate the mutation accumulation, worsen vascular strain and elevate the cancer, heart risks. Smokers who are deprived from sleep also experiences stronger nicotine cravings, which can lead to higher intake. People often underestimate this synergy by thinking that one cigarette is minor but when it gets combined with poor health, this biological stress can be disproportionately harmful, particularly for the immunity and long-term cancer susceptibility as well.

Since even light or occasional smoking is harmful, what early interventions can help smokers quit before irreversible damage?

Dr Shetty: Public Health emphasize that occasional” or “light” smoking is not all safe, harm occurs even at low exposures. Campaigns that personalize risk such as highlighting changes in voice in singers or cancer risks in families, have proven very effective. Graphic warnings, taxation and smoke free policies also reduces the uptake. To intervene on early basis routine screening for persistent hoarseness, throat lesions, or chronic cough in smokers could help to detect the precancerous changes. Digital quit support apps and counselling increase the quit rates. Ultimately message should focus not only on the morality but also on quality life issues like losing the natural voice and to motivate timely quitting. The best way to reduce the menace of tobacco use in society is to educate children and ensure they’re insulated from its temptation before they start the habit.