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Dr Rangan ChatterjeeWHY YOU'RE ALWAYS TIRED! - It All Begins With Your EVENING ROUTINE | Rangan Chatterjee
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Why Tiredness Starts With Your Evening Routine
Rangan Chatterjee explains that constant tiredness affects health, happiness and relationships. While some cases come from low iron, B12 or vitamin D, he says most stem from lifestyle, especially the evening routine. He introduces his five-step plan, beginning with the hour before bed.
- •Tiredness affects health, happiness and relationships
- •Nutrient deficiencies explain some cases, but most fatigue is lifestyle-driven
- •Evening routines matter as much as morning routines
- •Adults need the same wind-down signals we naturally give children
Step One: The Golden Hour Before Bed
He describes using the hour before bed as 'campfire time': separating work from the bedroom, avoiding stimulating content, and using an evening alarm, a hot bath or calm activities. He also describes the five-minute tea ritual with his wife and the story of his patient Susan.
- •The brain associates places with activities, so avoid working in bed
- •Change the tone: no news, arguments or finances in the evening
- •A hot bath lets core temperature drop, which helps sleep
- •The five-minute tea ritual improved his marriage and others'
- •Susan slept the same hours but felt more rested after yoga and music before bed
Step Two: Exercise and Its Timing
Evening exercise can relax some people but disrupt sleep for others. Chatterjee shares his own squash experience and a patient who swapped intense gym sessions for Pilates and slept better and woke with more energy.
- •Gentle exercise like yoga can help with switching off
- •Intense exercise close to bed can leave the heart racing and delay sleep
- •Chatterjee set a 5:00 cutoff for squash
- •A 52-year-old patient improved quickly after switching to Pilates
- •Responses differ between individuals
Step Three: Food, Late Eating and Caffeine
Drawing on Satchin Panda's research, Chatterjee recommends 12 hours without food and stopping eating two to three hours before bed. He offers practical tips for resisting evening snacking, explains how sugary foods can cause night waking, and advises caffeine only in the morning.
- •Many people eat across 15 hours a day, which we're not designed for
- •Stop eating two to three hours before bed if possible
- •Brush teeth after dinner and put leftovers away to add friction
- •High-sugar foods can cause a blood sugar drop that wakes you at night
- •If hungry, choose protein or healthy fats; keep caffeine to the morning
Step Four: Lighting, Screens and Circadian Rhythm
Chatterjee explains that circadian rhythms are set by light and dark and that we now get far more light at night. He suggests dimmer, lower, amber or red lighting, limiting screens, and trying amber glasses, illustrated by his son's red nightlight and patient Isabelle.
- •People are exposed to 10,000 times more light at night than in the 1800s
- •Avoid ceiling down lights; use lamps and dim lighting
- •A red nightlight gave his son an extra hour of sleep
- •Phones and tablets affect rhythms more than televisions
- •Bright light delays melatonin; amber glasses helped Isabelle feel sleepy earlier
Step Five: Reflection Activities for a Busy Mind
To quiet a racing mind at night, Chatterjee suggests gratitude practices, writing down tomorrow's tasks, and a two-question reflection on what went well and what to improve. He stresses making these easy to do, such as keeping a journal by the bed.
- •Gratitude reduces stress and anxiety and improves sleep
- •Humans have a negativity bias that needs counteracting
- •Keep a journal and pen by the bed to reduce friction
- •Writing down to-dos gets them out of your head
- •The two-question reflection is kind and compassionate
Breathing Practices to Switch Off
Breathing sends signals to the brain, and stress makes breath faster, shallower and more chest-based. Chatterjee teaches the three-pause-six and three-four-five breaths, explaining how a longer out-breath activates the relaxation side of the nervous system, and urges starting with one small change.
- •80% of people change their breathing when looking at their email inbox
- •Stressed breathing creates a vicious cycle that slow breathing can reverse
- •Three-pause-six: in for three, pause, out for six
- •Longer out-breaths activate the parasympathetic nervous system
- •Pick one thing and start small
Stress Behind Sugar and Alcohol Habits
Chatterjee argues that health conversations over-focus on food and movement, when food and drinking choices are often driven by underlying stress. January resolutions fail when sugar or alcohol serves a role, and he describes a patient whose midweek drinking spiral eased once he addressed Wednesday's stress with yoga.
- •Willpower-based January changes often fade by week three
- •Sugar or alcohol often soothes underlying stress
- •Address the stress and the behavior may change
- •A patient's Wednesday stress triggered a weekly drinking cascade
- •Yoga after work reduced his drinking and improved sleep
Why Patients 'Don't Comply': Communication in Medicine
Chatterjee says patients fundamentally want to feel better and that poor compliance reflects a paternalistic, rushed model. He contrasts two ways of delivering a type 2 diabetes diagnosis, discusses how communication is neither assessed nor taught in medicine, and describes the accredited Prescribing Lifestyle Medicine course he co-created.
- •The system is built for acute problems, not root causes
- •A rushed consultation leads to a drug-focused takeaway
- •Connecting and explaining can get results even in 10 minutes
- •Communication skills should be assessed and trained
- •His course is accredited by the Royal College of GPs and has trained nearly 1,000 professionals
What Stress Is and What It Does to the Body
Chatterjee defines stress as a perception of threat and explains that 70 to 90% of primary care conditions relate to it. He walks through how the ancient stress response now causes problems like high blood sugar, anxiety, low libido and gut issues, and how eating in a stressed state may cause food reactions, including the French paradox and a Crohn's patient.
- •Stress is a perception that the body is under threat
- •Blood sugar, blood pressure and amygdala changes become harmful when chronic
- •Stress switches off libido and digestion
- •Eating while stressed may explain some food intolerances
- •A Crohn's patient's symptoms fell 50% with 15 minutes of daily personal time and salsa dancing
Micro-Stress Doses and Your Stress Threshold
Chatterjee introduces micro- and macro-stress doses and the personal stress threshold. He shows how a typical morning can pile up 15 micro-stress doses before leaving the house, and argues that downtime and free tools build resilience, including for those with traumatic histories.
- •Micro-stress doses are small stressors that accumulate toward a personal threshold
- •Late nights, alarms, snooze, email and social media can add up before leaving home
- •Crossing the threshold leads to arguments and overreactions
- •Free tools make people more resilient to stress
- •Macro stressors need professional help, and these principles still support them
Finding Purpose Through the LIVE Framework
Discussing purpose as the hardest and most important pillar, Chatterjee explains why ikigai can feel stressful and presents his LIVE framework (love, intention, vision, engagement). He focuses on love and a daily dose of pleasure, illustrated by a patient who revived his passion for model trains and saw his mood, job and marriage improve.
- •A life lacking meaning is inherently stressful
- •Patients and a Japanese student found ikigai stressful rather than helpful
- •LIVE stands for love, intention, vision and engagement
- •Five minutes a day of something enjoyable is a starting point
- •The train-set patient regained energy, work satisfaction and closeness with his wife
Navigating the Holiday Season: Morning Routine, Movement and Breath
Asked about holiday stress, Chatterjee recommends downtime, a three-M morning routine of mindfulness, movement and mindset, and daily movement. He adds protecting travel time, using breathing techniques at stressful gatherings, and being mindful of alcohol's effect on sleep.
- •Downtime prevents accumulating micro-stress doses
- •Morning routine: mindfulness, movement, mindset, even in five minutes
- •A patient's five-minute routine reduced her eczema
- •Use a short walk or calm travel time to burn off stress
- •Alcohol damages sleep; learn to say no and use breathing to stay less reactive
