how do I handle being off my game at work because of a medical situation?

A reader writes:

About a year ago, I got prescribed a CPAP machine. Very important for, you know, supplying oxygen to my brain while I sleep, but one doozy of an adjustment period. It took me about a month to adjust to wearing it at night, and during that month I lowkey felt like I was dying. I was getting very little sleep, and that in small bursts. I was exhausted all the time, and exhaustion made me stupid and slow.

I work in a compliance-related role. My job involves assessing regulatory liability for my employer and potential misconduct by licensed employees. If I find against an employee, it’s the kind of thing that could follow them for the rest of their career, whether at my firm or any other they move to. If I find in favor of my firm where I should have found fault, that can open us up to regulatory complaints and investigations.

Operating on broken and insufficient sleep for a month while facing those potential consequences for bad calls scared the dickens out of me. I had productivity numbers to meet, but I simply could not stay focused enough to work at the normal speed, and awareness of the potential stakes of an error of judgment made me extra cautious. I was operating at about 40% of our expected performance, and even after I adjusted it took me some more time to fully get back up to speed as I paid off the sleep debt.

But a month-plus of turning out a fraction of the work I’m expected to do had a predictably terrible effect on my career. I wound up on a performance improvement plan and lost a lot of credibility with my boss. And unfortunately for me, my boss is the kind of guy who doesn’t really understand exhaustion as an excuse. As he sees it, either you’re so badly off you should take PTO or you’re fine and coming in to work and doing what needs doing. But I couldn’t exactly take an entire month of PTO, that’s far more than my allotment! And I don’t think short-term disability can be applied here.

I had a similar situation early in my career, too, when I was prescribed a strong bronchitis medication that interfered with my judgment and focus during the two weeks I was taking it. I only had five days’ sick time and had used half of it, so the only option I saw was to go to work high, which even at entry-level stakes is a bad idea.

So, how does one navigate these situations? My understanding is that accommodations for health are meant to offer you support to maintain the expected productivity, not to make it okay to underperform. Are there ways to approach an “I know I’m underperforming but I can’t do better until my body stops doing a stupid thing, which is some indefinite number of weeks away” conversation that could actually sound credible? How do people navigate this?

The wording you want is, “I’m dealing with a medical situation that is making it hard to be at 100% right now. I’m working with my doctor to resolve it and we’re hopeful I’ll be back to normal soon, but I wanted to mention it in case you notice me seeming off my usual game.”

Or, “I want to let you know that I’m dealing with a medical condition that has been wearing me out lately. I’m working with my doctor on a treatment plan and I don’t expect it to continue long-term, but I wanted to mention it in case you notice me seeming off.”

You don’t need to disclose details — just you might notice this, I’m working on it, and I’m hoping it will be resolved soon.

It’s ideal to say it before your boss talks to you about changes in your work, but if you didn’t, you can still say it once they do. The idea is to give your manager context for what’s happening so they don’t have to wonder if you’re just being careless or aren’t invested in your job anymore, or otherwise draw the wrong conclusions about what’s going on. Most managers will give you a lot more slack if you explain that yes, you’ve flagged it too, there’s a reason for it, and you’re working to resolve it.

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