I’m just coming out of two years of sleep deprivation.

Due to some sleep apnea issues (hopefully finally resolved), my now two-year-old daughter slept like a newborn until this summer. Which means, like the mom of a newborn, I was up every three hours at night for the last two years.

This has given me more experience in living with sleep deprivation than I ever wanted and plenty of time to think about how to survive when exhausted. What did I learn while functioning through two years of sleep deprivation?

Self-care matters even more when you’re not sleeping. When I’m sleep deprived, I either don’t want to eat, or I only want to eat donuts. Neither is a good option. And exercise? Forget it. Why would I want to do something that makes me more tired when I’m already tired?

Two years of donut-eating and couch-sitting, however, would not have been in my best interest. And if I couldn’t fix my sleep, I had to take control over some of the other self-care factors that have a major impact on mood. So I learned to plan giant vegetable stir-fry with enough leftovers for a week of lunches, and squeeze seven-minute workouts into breaks.It wasn’t perfect, but it was enough to keep me going.

Sleep deprivation messes with your head. Sleep deprivation feels suspiciously like depression. This is no surprise to anyone familiar with the literature showing sleep deprivation to be a major risk factor in depression and burnout. From my personal in-depth study of sleep deprivation, depression and sleep deprivation aren’t the same thing, but they’re close.

I learned not to trust my thoughts at the worst of sleep deprivation. Walking into clinic one morning, the thought popped into my head that I hate what I do and hope nobody shows up. Was that thought true? Absolutely not. Did it feel true? You bet. So I tried to recognize these negative thoughts as stemming from the sleep deprivation, instead of what I really believed. Just because the thoughts felt true didn’t mean they were true.

Similarly, I learned to roll with my emotions, even when they were unreasonable. If composing an email randomly induced feelings of panic, I had to accept the emotion. Just leave that email in the inbox and come back to it later when I had bandwidth to deal with it. The world has not yet ended because I didn’t respond to an email fast enough.

If possible, shift cognitive load when sleep deprived. I found that, within limits, I am able to provide patient care when I’m somewhat sleep deprived. I’m “on” and focusing, and the time moves by quickly. However, if I tried to write a research proposal, my brain would turn to mush. I did my best to shift the tasks involving deep processing to the rare days I’d had a full REM cycle, or accept that a simple paragraph could take a long time.

Sleep deprivation is impairment. I’ve never been in a car accident that was my own fault. Since my daughter was born, I’ve hit four parked objects. Good thing I drive an old Camry. Just because I survived a day of work didn’t mean I should have been driving, and I’m lucky nothing worse happened. I also remember talking with a patient near the end of a long shift when I was particularly tired, and realizing I couldn’t focus on what she was saying. And that I wanted to cry for no reason. That wasn’t safe or fair to my patient. In retrospect, I should have recognized that I was impaired and cancelled my patients for the rest of the day.

I’m happy to report that my daughter’s sleep is improved, and most nights (knock on wood) I sleep pretty well. My IQ has jumped back up a solid standard deviation, and the world is a bright and sunny place again. But my compassion for medical residents struggling with sleep deprivation through long shifts while adjusting to a new rotation and cramming their brains full of medical knowledge has increased exponentially.

So I say to you — take it easy on yourself. You don’t hate your life, you’re just tired. This too shall pass. And I will buy you a coffee.

Katie Fortenberry is a psychologist and an assistant professor, division of family medicine, University of Utah School of Medicine, Salt Lake City, UT.  This article originally appeared in Family Medicine Vital Signs.

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