Sleep Problems When On-Call: Causes and Solutions

Patient Expert

We already know that sleep is influenced by the type of job we have and that this could be down to work-related stress and shift work. A new study published in the Journal of Sleep Research in 2017 suggests that being on-call can also lead to poor sleep quality and less restorative sleep.

To better understand the relationship between being on-call and sleep (and to investigate the potential role of stress), researchers recruited 96 university students between the ages of 18 and 26 years. Participants were excluded if they had severe sleep disturbances or used sleep medication on a regular basis.

The study took place over two consecutive nights. For the first night, participants underwent a simulated on-call night. They were told to leave their phones switched on and that they could be called any time between the hours of 10:00 PM and 8:00 AM. If they received a call, they were told that they would need to get up, switch on a computer and complete several cognitive tasks for roughly 30 minutes before they could go back to sleep. Participants were not actually called during the on-call night.

For the second night, participants underwent a normal night without being on-call. For both nights, participants completed questionnaires before going to bed and after waking to measure sleep quality, levels of sleepiness, and stress levels. Objective sleep data was collected using wrist actigraphy.

How being on-call affected sleep quality

Researchers found that compared to the regular night, when participants were on-call they reported:

  • Taking significantly longer to fall asleep

  • Waking more often during the night

  • Spending more time awake during the night

  • Significantly lower sleep quality and more sleep problems

  • Feeling significantly less recuperated by morning

There were no significant differences between the on-call night and the regular night when it came to self-reported morning sleepiness or overall sleep duration.

Interestingly, when researchers analyzed objective sleep data collected from the actigraphy devices, they found no significant differences between the two nights when it came to sleep duration, time taken to fall asleep, number of awakenings, time spent awake during the night, or sleep efficiency.

How being on-call affected stress levels

Researchers found that stress levels were significantly higher during the on-call night and that this stress had a significant effect on self-reported sleep problems, sleep quality, number of nighttime awakenings, and time taken to fall asleep.

After further analysis, the authors of the study determined that the negative effects associated with being on-call were stronger for those who felt that being on-call was stressful.

Why being on-call affects sleep and stress

As pointed out by the authors of this study, the mere possibility of being called led to the perception of poorer sleep quality — and this effect was especially pronounced among those who found being on-call stressful. It appears, therefore, that the stress caused by the possibility of being called makes it more difficult to get a good night of sleep.

How to improve sleep and reduce stress when on-call

An article published in [Hospital Physician PDF shared the following tips on how to cope with being on-call:

  1. Make sure you eat well, drink plenty of fluids, and use the bathroom during the daytime prior to being on-call

  2. Try to get outside for a few minutes (particularly during sunset or sunrise, if possible) during an on-call shift

  1. Call a significant other at least once during an on-call shift to help avoid feelings of isolation

  2. Try focusing on the positive and avoid dwelling on the negative aspects of being on-call

  3. Remember that being on-call is a choice and that should you decide you can no longer tolerate it, you have the ability to look for a new job

  4. If you need to be awake when on-call, use caffeine carefully, try to stay physically active, consider a light therapy lamp, and get boring tasks out of the way at the start of your shift

  5. Find and temporarily retreat to a relaxing place if you feel stressed or emotionally overwhelmed

  6. Practice sleep discipline by limiting naps when on-call and sleeping as soon as possible when off-call. Stress reduction techniques can also be helpful

  1. Avoid driving home after being on-call or drive with extra caution since sleep deprivation affects your ability to drive

  2. Practice good sleep hygiene by sticking to a regular routine and avoiding caffeine in the five hour period before bed. In addition, try not to eat a heavy meal or drink alcohol shortly before going to bed

See more helpful articles:

Better Sleep With Shift Work

Is Napping Really Good for You?

Shift Work Disorder FAQ: Rotating Shifts