When I was younger I was always able to survive on not much sleep or irregular sleep. But being a junior doctor working night-shifts in my late 20s, was the first time I realised the link between sleep and how it affects my health and the way I feel.
I always knew about how fitness and diet related to my health and wellbeing, but it wasn't until doing nights that I realised how much sleep affects me, and how different you feel if you haven't had enough sleep. In particular, the six months I worked in A&E were probably the least healthy six months of my life partly because of the shift work. Thinking back to this time of my life, I realise how it continues to influence my routine now, especially because I travel a lot for work and this can disrupt my day to day.
Sleep is often underrated in terms of how we think about our health. Sleep is the time when we're healing and repairing our brain, our muscles - even our heart. Missing one night's sleep is fine but ongoing lack of sleep is linked to inflammation and a lot of chronic diseases including heart disease, Type 2 diabetes, blood pressure, some cancers and risk of stroke.
If I haven't had enough sleep, I'm able to cope for the first part of the day. So I almost go into over-drive but in the middle of the afternoon, I have poor concentration, a real lack of motivation, and I definitely crave carbohydrates. It also negatively impacts the next night's sleep and makes my sleep routine spiral.
I have a very busy life and I may not always stick to this but on a good day, I have an alarm that goes off at 10.45pm because my bed-time is 11.30pm - that's when it's lights out. The alarm is so I know when to start preparing to get to sleep. It helps immensely because I used to panic, then try and get everything done, then lie down and find I couldn't get to sleep.
At that point, I'm probably on my laptop, with the TV on and my phone next to me. So I need to think about turning all that off and making a list of things to do the next day which I have found really helpful.
I try and relax to calm my brain down. I start turning lights off, and sometimes I'll have a bath if I have time or a quick shower. I then make a chamomile tea and start preparing the bedroom.
It always surprises me how little attention we pay to our bedrooms. It isn't there to watch TV in or to work - a bedroom's only function is for sleep. And it's a critical function, at that. When we are preparing a room for a baby, an incredible amount of care goes into making sure there's the right cot, mattress, that it is quiet and really dark. Whether or not we have kids we need to remember the same amount of care should go into how you set your bedroom up.
Once I'm in the bedroom, I turn a lamp on and set my alarm but make sure the phone is turned away from me. I always have a paperback but sometimes I'm so tired I don't end up reading.
I used to have insomnia in the past, and sometimes it still happens where I can't sleep. So I get up out of bed, come downstairs, have a read for a while - maybe read a magazine that doesn't require much attention, maybe make another tea.
Then I find that just resets me, and I can sleep.
If I'm feeling stressed and anticipate I will have trouble sleeping, I've developed other rules. If I'm still awake after 30 mins of trying to sleep, I'll get up for a while as worrying about how long I've been lying awake just exacerbates potential insomnia.
I used to drink a lot of caffeine, and now as a GP, I stop my caffeine at 2pm. Everybody is different in the way they metabolise caffeine - some can drink it all day while it affects others quite strongly.
Also when you're drinking coffee, you don't know how much of a dose you're getting. And it takes about an hour for the caffeine to hit.
In a similar way, alcohol can also affect your sleep.
When you have an alcoholic drink, a lot of people think it might help them get to sleep easier. So you might have a nightcap or a glass of wine with dinner. But, although it does help you get off to sleep, it affects the quality of your sleep so even if you get 8 hours, chances are the high quality sleep is limited because you had alcohol. Even having a couple of glasses of wine, you may wake up feeling less refreshed. You may also get up in the middle of the night even if you don't remember.
I'm a realist and I travel a lot, and I know that it's not always possible to stick to my ritual. I am also guilty of having a lie-in on the weekend even though we say you should try and stick to the same time you'd normally get up. But - I think having a ritual in place helps you stick to some of it, when you are able.
So for instance when you go on holiday or fly for work, you're not always going to be able to stick to your routine, but trying as closely as possible to follow it will benefit you.