Across emergency rooms, power grids, and server rooms, millions of workers lie in bed each night suspended between rest and readiness — and research now confirms that this suspension alone is enough to erode the quality of sleep, even when no call ever arrives. The psychological weight of uncertainty, not merely the interruption itself, keeps the brain partially alert and the body incompletely restored. What looks like personal time is, in a deeper sense, still work — and the cumulative toll on health, cognition, and safety is neither minor nor abstract. The question now before employers and r
On-call work disrupts sleep even without calls, research shows
On-call workers experience chronic sleep deprivation affecting cognitive function, safety, and long-term health outcomes including increased accident risk and mental health difficulties.
Your brain stays partially vigilant, never fully surrendering to sleep.
Mark
So the finding is that just being on-call—even if you don't get called—damages your sleep. How confident are we in that?
Mimi
The research is solid. Sprajcer and Vincent have documented it. The mechanism is uncertainty. Your brain doesn't fully relax because it's waiting for something that might not happen.
Luke
But I want to be careful here. Are we talking about a study of on-call workers, or is this a controlled experiment? Because the real world is messier. People who are on-call might also be anxious about other things.
Mimi
Fair point. The research does show the correlation. Whether it's purely the on-call status or a mix of factors—that's still being worked out.
Mark
What about the people who say they actually like on-call work? That the flexibility suits them?
Mimi
Some do. But the sleep data doesn't care about preference. The disruption happens whether you like the arrangement or not.
Luke
And we don't know yet what the safe limit is. They're starting that research now. So right now, employers don't have clear guidance on how many nights or calls is too many.
Mimi
Exactly. That's why the organizational piece matters so much. Until we have those numbers, companies need to at least think about recovery time.
Mark
If you're a nurse or a doctor, you can't just opt out. So what's realistic here?
Mimi
Better scheduling. Not requiring people to come in early after a rough on-call night. Building in actual off-call time. It's not revolutionary, but it requires intentional design.
Luke
And the long-term health risks—accidents, diabetes, heart disease—those are real but they're also downstream. The immediate problem is cognitive function. You're making decisions while sleep-deprived.
Mimi
Which in emergency medicine or utilities work is exactly when you can't afford to make mistakes.
Mark
So this is a safety issue, not just a comfort issue.
Mimi
Completely. That's what makes it urgent.
The Pulse
- Workers on standby carry an invisible burden: the mere possibility of being called is enough to prevent the brain from fully surrendering to sleep, even on quiet nights.
- The consequences compound over time — slower reactions, impaired judgment, deteriorating mood, and long-term risks including accidents, heart disease, and mental health difficulties.
- Individual workarounds exist — earlier bedtimes, optimized sleep environments, avoiding stimulants — but these are personal patches on a problem that is fundamentally structural.
- Researchers Madeline Sprajcer and Grace Vincent are now working to establish concrete, evidence-based limits on how much on-call work a person can sustain before their health begins to deteriorate.
- The path forward runs through employers: roster design that builds in genuine recovery time after demanding on-call nights is the intervention most likely to make a measurable difference.
Across emergency rooms, power grids, and server rooms, millions of workers lie in bed each night suspended between rest and readiness — and research now confirms that this suspension alone is enough to erode the quality of sleep, even when no call ever arrives. The psychological weight of uncertainty, not merely the interruption itself, keeps the brain partially alert and the body incompletely restored. What looks like personal time is, in a deeper sense, still work — and the cumulative toll on health, cognition, and safety is neither minor nor abstract. The question now before employers and researchers alike is how to design working life so that rest can be genuinely reclaimed.
The phone could ring at any moment — and that possibility alone is enough to ruin a night's sleep. Research by Madeline Sprajcer and Grace Vincent has confirmed something workers in emergency services, healthcare, utilities, and IT have long sensed: the anticipation of being called, not just the call itself, degrades rest. The brain stays partially vigilant, never fully letting go. It is the same mechanism behind the Sunday scaries — dread of what might happen keeping you awake before anything actually does.
On-call work is embedded in the infrastructure of modern life. Doctors, electricians, IT workers, retail managers, and rideshare drivers all inhabit this in-between state — technically off the clock, but never truly free to disconnect. The stakes vary enormously, from life-or-death decisions to routine troubleshooting, but the common condition is the same: personal time that cannot be fully personal.
The health costs are serious and well-documented. Sleep is when the brain consolidates memory, regulates emotion, and restores attention; when the body repairs tissue and maintains cardiovascular and immune function. Chronic disruption leaves that work incomplete. Concentration falters, reaction times slow, and over years the risks extend to accidents, weight gain, diabetes, and heart disease. In high-stakes fields, a single lapse in judgment can have immediate consequences.
Some workers adapt individually — banking sleep before an on-call night, optimizing their bedroom environment, avoiding caffeine and alcohol. But Sprajcer and Vincent argue these are personal solutions to an organizational problem. Employers have the real leverage: rosters that build in genuine recovery time, and schedules that do not demand early starts after disrupted nights. The researchers are now working to define safe limits — how many calls, how many nights, before health begins to deteriorate in measurable ways. That guidance is still forthcoming, but the underlying message is already clear: the cost of on-call work is real, it is paid in sleep, and both workers and the organizations that depend on them have reason to take it seriously.
The phone could ring at any moment. You're lying in bed, eyes closed, but part of your brain never fully lets go. You're on-call tonight, which means sleep becomes conditional—something you might have to abandon without warning. The research is clear: that mere possibility, that ambient uncertainty, is enough to wreck your rest even if the call never comes.
On-call work is woven into the fabric of essential services. Doctors wait for hospital pages. Electricians carry phones for grid emergencies. Uber drivers stay logged in between fares. Retail managers know they might cover a sick shift. IT workers stand ready to restart systems at 3am. The work itself varies wildly—some calls demand split-second decisions with life-or-death stakes; others are routine troubleshooting. But the common thread is the same: you cannot fully disconnect. You must remain reachable, alert, ready to shift from personal time into work mode with minimal notice, often in the middle of the night.
For years, the assumption was straightforward: on-call work disrupts sleep when calls actually come. And yes, that's true. Multiple interruptions, long call-outs, high-stress tasks, and overnight work all eat into the hours available for rest. But research by Madeline Sprajcer and Grace Vincent reveals something more subtle and more troubling. The anticipation itself—the simple knowledge that you might be called—degrades sleep quality. Uncertainty is the culprit. Your brain stays partially vigilant. You drift off but never fully surrender. It's the same mechanism that produces the Sunday scaries, that pre-work dread that keeps you awake on a Sunday night even though nothing has happened yet.
The cost of this disruption extends far beyond feeling tired. Sleep is when your brain consolidates memories, processes emotions, and restores attention. Your body repairs tissues and bolsters immune, hormonal, and cardiovascular function. When sleep is regularly fragmented or shortened, that nightly maintenance work goes incomplete. Concentration falters. Reaction time slows. Mood deteriorates. Decision-making becomes harder. Over time, chronic poor sleep correlates with increased accident risk, mental health difficulties, weight gain, diabetes, and heart disease. For workers in high-stakes fields—emergency medicine, utilities, emergency services—the stakes are not abstract. A slower reaction time or a lapse in judgment can have immediate, serious consequences.
Some on-call workers have found their own workarounds. Going to bed earlier on nights when on-call is one strategy, a way to bank sleep before the potential interruption. Optimizing the bedroom—keeping it cool, dark, quiet—helps maximize whatever sleep time remains available. Avoiding caffeine, alcohol, and large meals before bed can improve sleep quality. But these are individual adaptations to a structural problem.
The real solution, Sprajcer and Vincent argue, lies with employers. Organizations can design on-call rosters that provide genuine recovery time. After a busy on-call night, workers should not be required to arrive early the next morning. Schedules should build in enough off-call periods for workers to actually rest and recover. The research is still evolving—Sprajcer and Vincent are launching a new project to determine how much on-call work is sustainable, how many calls and nights workers can reasonably handle without their health deteriorating. Clear guidance for employers is coming, but it's not here yet.
On-call work is not going away. Critical services depend on it. But the research makes clear that the cost is real and measurable, paid in sleep and in the cascade of health effects that follow. Both workers and the organizations that employ them have a stake in getting this right.
Notable Quotes
Simply knowing you are on-call is associated with worse sleep. Uncertainty seems to be the key factor.— Madeline Sprajcer and Grace Vincent
Workers can only do so much to protect their sleep while on-call. A lot of the solution lies in how organisations design on-call work schedules.— Madeline Sprajcer and Grace Vincent
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Politics & Governance