If you have started having panic attacks, it is understandable to wonder about the coffee you drink, the night out you had, or the vape you reach for when you feel anxious. You want to know whether something you are doing is making the attacks more likely.
Caffeine, alcohol and nicotine can affect how you feel, but a racing heart after a drink does not tell us its cause by itself. I would look at what you are using, when you use it, and what you have come to rely on it for. That gives you something practical to discuss or change without having to monitor every sensation.
This article is for adults reviewing these habits alongside their understanding and treatment of panic attacks. If symptoms are new, severe or different from your usual pattern, get medical advice rather than assuming that a drink or panic explains them.
Caffeine and panic
Caffeine can leave you shaky, make your heart beat faster or interfere with sleep. People differ in how sensitive they are to it. If a fast heartbeat already frightens you, the sensation and your interpretation of it can become difficult to separate.
Start by looking at your usual intake. Coffee, tea, cola, energy drinks and some supplements can all contribute. A large drink may also contain more than one serving. The FDA’s caffeine guidance explains why the amount and individual sensitivity both matter.
For example, you might notice that your second coffee has gradually become a large afternoon coffee because you are sleeping badly. A reasonable first change could be making that drink smaller or moving it earlier. There is no particular number of coffees that guarantees you will or will not panic.
If you regularly have caffeine and want to reduce it, do so gradually. Stopping suddenly can bring unpleasant withdrawal symptoms. Ask your pharmacist or GP about your intake if you take medication, have a relevant health condition, are pregnant or are unsure what is suitable for you.
Energy drinks
Check the caffeine amount on the container and count it alongside your other drinks. The name of a product tells you very little about the dose, and caffeine content varies.
I would also ask what the drink is doing for you. Perhaps it gets you through an early shift, a long drive or an afternoon when you are exhausted. If you simply remove it while keeping the same demands, you may struggle with the change. Persistent exhaustion deserves attention in its own right.
A useful plan might involve an earlier bedtime, a break you have been skipping, or a conversation about your workload, alongside reviewing the drink. If tiredness is affecting safe driving or work, address that immediately rather than using more caffeine to carry on.
Alcohol and panic
You may feel more relaxed while drinking and much more anxious the following day. Poor sleep, nausea and worry about the evening can make an already difficult morning worse. The HSE describes this familiar next-day anxiety as “the fear” or hangxiety.
It is worth looking at the role alcohol has taken on. Do you feel unable to meet friends without a drink first? Have you started drinking after an attack because you are frightened of another one? Those are useful things to tell your GP or therapist; you do not have to wait until drinking has caused a crisis.
If you may be dependent on alcohol, get medical advice before cutting down or stopping. Withdrawal can cause anxiety, sweating, shaking and a racing heartbeat, and can become dangerous. Those symptoms should not automatically be treated as panic. A history of withdrawal, drinking to relieve morning symptoms, or concern about dependence is a reason to arrange support, rather than try a sudden alcohol-free experiment.
Seizures, hallucinations or severe confusion after reducing or stopping alcohol need emergency help: call 112 or 999 in Ireland. The NHS guidance on alcohol-use disorder explains the withdrawal risks.
If dependence is not a concern, reducing alcohol may be a useful part of your plan. Give thought to the situation as well as the drink. Meeting a friend somewhere you do not usually drink, for example, can help you practise spending time together without relying on alcohol to get through it.
Vapes and nicotine
With vaping, there may be more than one issue to address. You may be concerned about sensations after using nicotine, and you may also have come to feel that you cannot manage an anxious situation without your vape.
Nicotine dependence can make change uncomfortable. Cravings, irritability, difficulty concentrating and disturbed sleep may occur when you stop. They do not, by themselves, mean that your panic disorder is getting worse. Discuss worrying symptoms and a suitable quitting plan with your pharmacist, GP or stop-smoking service.
If you use a vape to stay off cigarettes, protect that progress when planning a change. The NHS guide to quitting vaping discusses gradual reduction and support for withdrawal. You do not have to prove anything about your ability to cope by making an abrupt change on your own.
Should you avoid anything that makes your heart race?
It can be sensible to reduce caffeine while also working on your fear of familiar, medically assessed panic sensations. Cutting down does not mean that every change in your heartbeat has to be prevented.
The distinction depends on your situation. Rest prescribed during an illness, asthma treatment and other medical precautions are part of looking after yourself. They should not be removed as an exercise in facing panic. If you are unsure which activities are appropriate, agree that with your clinician.
Look for a useful pattern without checking all day
You may already know the main pattern: several caffeinated drinks after poor sleep, anxiety after drinking, or vaping more during difficult meetings. If it is less clear, a short note once a day can help. Record the drink or nicotine use, the approximate time and anything relevant about sleep or the situation.
Keep the record brief. You do not need repeated pulse readings, a list of every sensation or an exact panic score each hour. If recording makes you more preoccupied with your body, stop and discuss another way of reviewing it. Use the notes to help you decide what to discuss or change.
What to change first
Start with the habit that seems to be causing a problem. For example, you might gradually reduce your afternoon coffee, ask for help with drinking or get support to stop vaping. Try to keep meals and bedtime reasonably regular, too.
If symptoms started after a new medicine or a change in dose, speak to your prescriber or pharmacist. Do not stop prescribed medication as part of a self-directed experiment.
Look at what has changed in your day-to-day life as well as how anxious you feel. Are you sleeping more comfortably? Can you meet a friend without needing a drink first? Are you spending less time trying to work out what each sensation means? These questions are more useful than expecting the complete absence of anxiety.
When the fear becomes health anxiety
Sometimes the worry continues even after you have reviewed the substance and sought appropriate medical advice. You might repeatedly check whether caffeine has damaged your heart or search for an explanation every time you feel a flutter.
That deserves help too. My article on body monitoring in health anxiety explains how constant attention to sensations can keep concern going. Follow the medical monitoring plan you have been given; the concern here is the extra checking you do to try to feel certain.
When changes to drinks and nicotine are not enough
You can make sensible changes to these habits and still need help with panic. That does not mean you have failed to identify the right food, drink or trigger. The fear of another attack and the activities you have stopped doing may need attention of their own.
My guide to CBT for panic attacks explains that work. If you need practical guidance during a familiar attack, you can also use my step-by-step panic guide. Bring any concerns about substances, withdrawal or medication into your treatment plan rather than trying to manage them separately.