Across industries where readiness is required around the clock, millions of workers carry an invisible burden: the mere anticipation of being called is enough to prevent the deep rest the body needs. Research emerging from sleep science reveals that uncertainty itself — not just the call that arrives — is the agent of harm, quietly eroding cognitive function, emotional stability, and long-term physical health. This is not simply a story about tired workers; it is a story about how modern labour structures have made a fundamental human need negotiable. The question societies now face is whether
On-Call Work Disrupts Sleep Even Before the Phone Rings
On-call workers experience chronic sleep disruption affecting cognitive function, mental health, and long-term disease risk, with particular impact on emergency services and healthcare workers.
Your body knows you're on-call, even when the phone never rings.
Mark
So the phone doesn't even have to ring for the damage to happen?
Mimi
Exactly. The uncertainty itself is the problem. Your nervous system stays partially activated. You're not sleeping as deeply because part of your brain is listening for that call.
Mark
That seems almost cruel—you lose sleep whether you get called or not.
Mimi
It is. And it compounds. One disrupted night is manageable. But on-call workers often do this repeatedly, week after week. The sleep debt accumulates.
Mark
What happens to someone after months of that?
Mimi
Their ability to think clearly starts to erode. They make more mistakes. Their mood becomes fragile. And the longer it goes on, the higher their risk of serious health problems—heart disease, diabetes, depression.
Mark
Can a worker just refuse to be on-call?
Mimi
In theory, they have the right to disconnect. But in practice, many jobs require it. A doctor can't refuse to be on-call if that's how the hospital schedules them. They need the job.
Mark
So it falls to employers to fix this?
Mimi
Partly. But employers often don't see it as their problem. That's where the research comes in—showing that this isn't just about individual resilience. It's a systemic issue that requires systemic solutions.
O Pulso
- Even on silent nights, on-call workers' brains remain partially vigilant, treating uncertainty as a threat and denying the body the deep, restorative sleep it requires.
- The cascading consequences are serious: impaired memory, slowed reaction time, destabilised mood, and a long-term elevation in risk for accidents, mental illness, and chronic disease.
- Individual coping strategies — earlier bedtimes, darkened rooms, caffeine avoidance — offer partial relief but cannot override the structural reality of a 2 a.m. call followed by a 7 a.m. shift.
- Australia's right-to-disconnect laws, in place since 2024, have not reached the millions in emergency services, healthcare, utilities, and gig work who remain tethered to availability by the nature of their roles.
- Researchers are now working to establish evidence-based limits on sustainable on-call scheduling, while employers are being urged to build genuine recovery time into rosters before the human cost compounds further.
Across industries where readiness is required around the clock, millions of workers carry an invisible burden: the mere anticipation of being called is enough to prevent the deep rest the body needs. Research emerging from sleep science reveals that uncertainty itself — not just the call that arrives — is the agent of harm, quietly eroding cognitive function, emotional stability, and long-term physical health. This is not simply a story about tired workers; it is a story about how modern labour structures have made a fundamental human need negotiable. The question societies now face is whether the systems that depend on perpetual human availability can be redesigned before the cost becomes irreversible.
It is four in the morning, and your phone might ring. Even if it never does, your body already knows it could — and that knowledge alone is enough to break your sleep.
Millions of Australian workers live in this state of perpetual readiness: emergency doctors, paramedics, utility crews, gig-economy drivers. Though not officially working, they cannot fully switch off. Since 2024, most employees have had a legal right to disconnect from after-hours contact, yet for those in essential roles, availability remains an occupational reality. And the research is now clear that simply carrying the uncertainty of a possible call degrades sleep quality in the same way the call itself would — the brain stays partially alert, the body never fully releases. It is the same mechanism behind the Sunday scaries, except it plays out night after night.
The consequences extend well beyond fatigue. Sleep is when the brain consolidates memory, regulates emotion, and restores attention; when the body repairs tissue, balances hormones, and maintains the heart. Chronic fragmentation of that process raises the risk of accidents, mental health disorders, weight gain, diabetes, and cardiovascular disease. The foundation, once cracked, destabilises everything built upon it.
Some workers adapt by going to bed earlier on standby nights, or by carefully managing their sleep environment. These measures help, but they cannot solve the structural problem: no amount of personal optimisation prevents an employer from calling at 2 a.m. and expecting attendance at 7 a.m. the same morning.
The responsibility, researchers argue, must shift toward organisations. Roster design that builds in genuine recovery time, and flexibility that protects workers from consecutive on-call and early-shift obligations, can meaningfully reduce harm. The science of exactly how much on-call work is sustainable is still being written — but the direction is already plain. On-call work is not going away. The urgent task is learning how to structure it so that the people sustaining our hospitals, power grids, and emergency services are not quietly paying with their health.
It's four in the morning. You've finally managed to fall asleep, and then your phone buzzes. Work. You have to get up and go in. But here's what the research is revealing: even on the nights when that call never comes, your body knows it might. Your sleep is already broken.
Since 2024, Australian law has given most workers the right to disconnect—to refuse work calls outside their regular hours. Yet millions of people across the country still live in a state of perpetual availability. They're on-call: emergency room doctors, paramedics, utility workers, retail staff covering gaps, even gig-economy drivers waiting for the next job. They're not officially working, but they can't fully switch off. They have to be reachable. They have to be ready. And that readiness, it turns out, comes with a cost that begins long before any phone rings.
The mechanism is straightforward enough. If a call actually comes during sleep, it disrupts you—obviously. Multiple calls, long calls, stressful calls: they all eat into the limited hours available for rest. But research now shows something more subtle and perhaps more troubling. Simply knowing you're on-call, simply carrying the uncertainty of whether you'll be called, is enough to degrade sleep quality on its own. Your brain doesn't fully relax. Your body stays partially alert. It's the anticipation itself that does the damage, the same psychological mechanism that produces what people call the Sunday scaries—that dread before the work week begins.
Why this matters goes beyond feeling tired. Sleep is when your brain consolidates memories, processes emotions, and restores your capacity to pay attention. Your body repairs tissues, bolsters your immune system, regulates hormones, and maintains cardiovascular health. When sleep is regularly cut short or fragmented, that nightly maintenance work never completes. Concentration falters. Reaction time slows. Mood destabilizes. Decision-making becomes harder. Over time, chronic poor sleep is linked to higher rates of accidents, mental health problems, weight gain, diabetes, and heart disease. Sleep is foundational. When the foundation cracks, everything built on it becomes unstable.
On-call workers have developed some strategies. Many go to bed earlier on nights they're on standby, trying to bank sleep before the potential disruption. A cool, dark, quiet bedroom helps. Avoiding caffeine, nicotine, and alcohol in the hours before bed makes a difference. But individual solutions can only go so far. A worker can optimize their bedroom and their bedtime routine, but they can't control whether their employer calls them at 2 a.m. or whether they'll be expected to show up for their regular shift at 7 a.m. the next morning anyway.
This is where organizational responsibility enters the picture. Employers designing on-call schedules have real power to reduce harm. Providing flexibility so workers aren't required to come in early the morning after a busy on-call night matters. Building rosters that give workers genuine time off-call to recover is essential. Right now, the research on exactly how much on-call work is sustainable—how many calls, how many nights—is still developing. But the direction is clear: on-call work is necessary to keep hospitals running, power grids stable, and emergency services operational. The question is no longer whether it should exist, but how to structure it so the people doing it don't pay with their health.
Citações Notáveis
Uncertainty seems to be the key factor—if you aren't sure whether you will be called or if you are worried you might miss the call.— Research cited by Madeline Sprajcer and Grace Vincent, CQUniversity Australia
Workers and organisations both have important roles to play in helping these critical workers to get enough sleep.— Madeline Sprajcer and Grace Vincent
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