Cutting caffeine is one of the easiest, highest-yield moves for both anxiety and sleep, and people have very little awareness of how much it drives either. Ask about it, and do not trust 'coffee doesn't affect me', before reaching for an anxiety or sleep medication.
Anxiety
People coming to a psychiatrist for anxiety should be drinking at most one cup of coffee.
“People who are coming to a psychiatrist for anxiety should be drinking at most one cup of coffee”
38:31Anxiety Medications Tier List: The Best and Worst Treatments for GADJul 2026 Cutting caffeine is low-hanging fruit. People have very little awareness of how much it feeds their anxiety, and while it is hard to get someone off their triple espressos, it makes a huge difference.
“That is a low hanging, super easy thing. Patients often have no, very little, not patients, people have very little awareness of how much anxiety, how much caffeine can impact their anxiety and reduce, like, you know, it's very hard to get someone to reduce their triple espressos from Starbucks. It makes a huge difference”
1:00:40Psychiatrist's Guide to Anxiety Medications: First Line to Last ResortJun 2025
Sleep
Limiting and timing stimulants is S tier for sleep. That includes caffeine and basically anything that produces wakefulness or suppresses sleep.
“we forgot to put limiting and timing stimulants onto the board. That's an S tier for sure. Go ahead and throw it on there. Stimulants, including caffeine, basically anything That produces wakefulness physiologically or suppresses sleep physiologically”
48:44Sleep Medications Treatment Tier List: Best Insomnia Medications RankedAug 2026 It is very hard to tell subjectively how a stimulant affects your sleep. If a patient is drinking several espresso shots, talk about that before starting a sleep medication.
“for stimulants, it's really, really hard to subjectively know how a stimulant affects your sleep. Trust your gut. If a patient is drinking three espresso shots, please talk to them about the impact of five espresso shots before starting a sleep medication”
50:42Sleep Medications Treatment Tier List: Best Insomnia Medications RankedAug 2026 Even four cups of coffee at 8 a.m. can affect sleep that night, when it seems like it should be out of their system. We see it all the time.
“If someone's drinking four cups of coffee at 8 a.m., it could have an impact, even if it doesn't make sense that it should be out of their system. I see all the time”
1:03:18Insomnia and Sleep Medications in PsychiatryDec 2024
Pearls
When screening for hypomania, remember it is not uncommon for people to sleep two or three hours before something important, feel wired and energetic, or compensate with caffeine.
“it's not uncommon for people to sleep two hours, three hours, and if they have something important, to feel wired, to feel energetic, to feel like they have lots of energy, or to compensate with caffeine”
32:55How to Diagnose Bipolar Disorder: The Interview Framework That Beats Screening QuestionsFeb 2026 Caffeine and melatonin are both metabolized by CYP1A2, so it is possible they compete.
“it is possible that it could be competitive use. I believe of cytochrome 1A2 because both caffeine and melatonin are metabolized by 1A2”
53:00Sleep Medications Treatment Tier List: Best Insomnia Medications RankedAug 2026
It also comes up on
- Differential diagnosisIn every patient, consider substances, herbs, supplements, natural remedies, energy drinks, caffeine, medical conditions and other psychiatric conditions, eating disorders included: if you are not eating correctly, you will not function correctly.
- ADHDStart at the top of the hierarchy with organic and medical causes (brain, thyroid, cortisol), and in every patient ask about substances, herbs, supplements, energy drinks, caffeine and eating problems.
- Substance use disordersIn every patient, consider substances, herbs, supplements, natural remedies, energy drinks, caffeine, medical conditions and other psychiatric conditions.
From these episodes
- Sleep Medications Treatment Tier List: Best Insomnia Medications RankedAug 2026 · 3 points
- Anxiety Medications Tier List: The Best and Worst Treatments for GADJul 2026 · 1 point
- How to Diagnose Bipolar Disorder: The Interview Framework That Beats Screening QuestionsFeb 2026 · 1 point
- Psychiatrist's Guide to Anxiety Medications: First Line to Last ResortJun 2025 · 1 point
- Insomnia and Sleep Medications in PsychiatryDec 2024 · 1 point
Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.