Do You Have Trouble Sleeping?

Sleep deprivation has far-reaching consequences, impairing judgment, undermining decision-making, affecting ethical behavior, disrupting emotions, and even threatening public safety in both everyday life and critical high-stakes environments.

Sleep Loss Impairs Decision-Making, Leading To Catastrophic Outcomes in High-Stakes Situations

Sleep deprivation severely impairs decision-making, which can have dire consequences in situations where people operate vehicles, manage complex systems, or make critical choices under pressure.

Drowsy Operators Cause Fatal Disasters: The 2013 Rockefeller Derailment and 2001 Hart Crash

William Rockefeller, a train engineer in New York, operated an early morning commuter train that derailed in December 2013, killing four people and injuring 60. While initially stating he was dazed, later investigation revealed he had likely fallen asleep due to a combination of sleep apnea—a disorder in which a person repeatedly stops breathing and briefly awakens throughout the night, leading to poor sleep quality—and a recent shift change that caused circadian misalignment. The inability to remain alert at a critical moment, compounded by sleep debt, led him to miss a sharp turn at excessive speed; he braked, but it was already too late.

A parallel catastrophe occurred in the UK in 2001 when Gary Hart, after driving much of the night, fell asleep at the wheel. His vehicle veered onto train tracks, resulting in a derailment and a head-on collision between trains that ultimately killed 10 people and injured 82. Hart’s sleep loss not only caused him to drive off the road but also contributed to poor decisions and panic following the crash.

Moscow Taxi Driver, Exhausted After 20-hour Shift, Mistakenly Hit Accelerator, Striking Pedestrians; Shows how Sleep Debt Impairs Motor Control and Decision-Making

In 2018, Moscow taxi driver Chingiz Anarbek Ulu had been working a 20-hour shift during the World Cup festivities when, already drifting off, he intended to brake for a pedestrian but instead hit the accelerator, running into a crowd. After the incident, he exited the vehicle and fled, another example of impaired judgment through sleep debt. Interviews revealed that fatigue directly contributed to his impaired motor control and the poor decisions that followed.

Sleep-Deprivation Hinders Decision-Making, Causing Poor Choices Under Pressure

Chris Barnes states that sleep deprivation broadly impairs the ability to make sound decisions, especially in novel, high-pressure situations. Sleep-deprived people are much worse at adapting to unexpected problems—precisely the moments that often determine outcomes in life-changing events.

Sleep Loss Impairs Workplace Safety, Ethics, and Judgment

Sleep deprivation affects not just individuals in dramatic circumstances, but also everyday workplaces, with implications for injuries, engagement, and even ethical behavior.

Sleep Loss Affects Workplace Injuries, Engagement, and Moral Awareness; Deficits Compound Over Multiple Nights

Barnes details research showing that as little as an hour of lost sleep can meaningfully affect workplace outcomes, including a rise in injuries and lower engagement at work. Nap studies indicate that even brief rest periods can improve immediate performance. Using devices late at night also erodes sleep, leading to workers who are less effective and less engaged the following day.

Sleep Deprivation Lowers Moral Awareness, Simplifying Complex Decisions and Increasing Workplace Unethical Conduct

Sleep deprivation impacts our ability to recognize the moral dimension of choices. Sleep-deprived people exhibit poorer self-control and are more likely to behave unethically—such as lying, credit-stealing, or blaming others. Decision-making becomes simplified, and nuanced moral aspects are overlooked, increasing the risk of unethical conduct.

Singapore, Taiwan Data Shows Car Crash Spikes After Early Morning European Soccer Broadcasts, Highlighting Community Safety Impacts of Voluntary Sleep Loss

Barnes and co-author Sam Yam studied taxi company and general traffic crash data in Singapore and Taiwan, finding spikes in accidents following popular early-morning European soccer matches. Voluntary sleep deprivation for entertainment thus leads to increased risk and harm across entire urban communities, not just among professional drivers.

Industrial Disasters Like the 2005 Bp Oil Refinery Explosion Partly Resulted From Employees Accumulating 43 Hours of Sleep Debt Due to Weeks of 12-hour Shifts and Long Commutes

Major disasters can stem from chronic workplace sleep loss. The 2005 BP oil refinery explosion, which killed 15 workers and injured 180, was linked in part to employees working a month of 12-hour shifts and enduring up to two-hour commutes, resulting in accumulated sleep debts of up to 43 hours. Investigators noted that fatigue increased the likelihood of critical errors leading to the catastrophe.

Sleep Deprivation Disrupts Emotions and Amplifies Minor Issues, Impacting Relationships and Work

Sleep loss does not just affect physical and ethical response; it directly impacts emotional regulation and the ability to face everyday frustrations.

Effects of Sleep Deprivation on Emotional Control

Barnes explains that sleep deprivation leads to increased irritation, frustration, and anger, as well as difficulties in mood regulation and potential depressive symptoms. Small problems become overwhelming.

Sleep Deprivation Weakens Prefrontal Cortex-Amygdala Interaction, Intensifying Emotional Responses

This occurs in part because sleep loss disrupts the communication between the brain’s prefrontal cortex, involved in rational decision-making, and the amygdala, which governs emotional responses. The result is bigger, less-controlled emotional reactions.

Courtney Cronin's Profanity Outburst On-air Due to Sleep Deprivation Making Technical Difficulties Intolerable

ESPN sportscaster Courtney Cronin, appearing live after little sleep during the NFL combine, became visibly frustrated with technical difficulties and eventually uttered a profanity on air. She later cited sleep deprivation as the main reason a routine irritation provoked an outsized, public outburst.

Circadian Misalignment From Shift Work and Time Changes Causes Sleep Deprivation and Impaired Alertness

Circadian misalignment—working against our natural sleep-wake rhythms—further amplifies the dangers of sleep loss.

Nuclear Disasters Like Chernobyl and Three Mile Island Occurred Between 1:30 and 4 A.M. When Workers, Driven Toward Sleep, Must Handle Complex Systems They Are Unprepared to Troubleshoot

Both Chernobyl and Three Mile Island nuclear disasters occurred in the early morning hours, a period when workers are most likely to be physiologically driven toward sleep and least prepared to deal with novel technical emergencies. Shift work that conflicts with circadian rhythm renders workers—especial ...

Chronic pain is commonly misunderstood as a problem of anatomy and physiology alone, leading to treatments that focus strictly on the physical body. However, Rachel Zoffness and Shankar Vedantam emphasize that decades of neuroscience show pain is far more complex.

Pain Arises From Biological, Psychological, and Social Factors Beyond Just Tissue Damage

Zoffness explains that the predominant myth around pain—one that has persisted for decades—is that it is a purely biomedical issue needing only biomedical solutions such as medication or surgery. She challenges this, stating that 65 years of neuroscience research has established pain as a biopsychosocial phenomenon, the result of interacting biological, psychological, and social factors. Biological elements include genetics, tissue damage, inflammation, exercise, sleep, and diet. However, if treatment focuses only on biology, two-thirds of the pain problem are missed.

She uses the metaphor of a “pain recipe,” with biological, psychological, and social ingredients all contributing to a person’s experience. Psychological components include emotions and the brain’s fear and stress centers, while social contributors involve relationships, social support, and circumstances of daily living.

Neglecting non-biological factors, says Zoffness, leads to endless cycles of surgery and medication that may not address the actual drivers of pain. While these treatments can be life-saving and important, they often fall short when used in isolation.

A striking example comes from Usain Bolt. Despite having severe scoliosis—his spine twisted into an “S” and causing his legs to be different lengths—Bolt experienced very little pain and became the fastest man in the world. If structural damage alone caused pain, he would have been incapacitated instead of setting Olympic records. This demonstrates that pain and damage do not always correlate; one can have significant tissue abnormalities and little or no pain.

Pain Levels Vary Among Patients With Identical Tissue Damage Due to Psychological and Social Factors

Individuals with similar tissue damage can have widely different pain experiences because of non-biological influences.

One listener, Zara, was diagnosed with endometriosis after a blood test revealed abnormal results. In endometriosis, there is often a disconnect: some women with significant tissue overgrowth report little pain, while others with mild overgrowth suffer severe pain. Research shows that the amount of tissue damage does not predict pain levels, reinforcing the need to look beyond physical findings.

Another caller, David, suffered from phantom pain in his amputated leg for years after a motorcycle accident. Despite successful surgical healing and no physical abnormalities on examination, pain persisted. When his surgeon found everything "perfectly healed" on X-ray and compared David unfavorably to patients who run marathons after similar surgeries, David felt blamed and unsupported. Relief came not only from further treatment but also from understanding pain as a phenomenon not solely tied to tissue status.

Courtney Cronin describes living with interstitial cystitis, experiencing unrelenting pain that worsened with a fearful, combative mindset. Upon realizing that her pain was tied in part to perceived danger and fear, she shifted towards self-soothing and compassion. This psychological transformation brought h ...

Rachel Zoffness explains how psychological and social forces can intensify or alleviate health problems, especially pain. These factors—fear, relationships, mindset, and attention—shape brain chemistry and bodily responses, influencing pain at every level.

Fear Cycle: Pain Triggers Fear, Heightens Pain, Tension Worsens Experience

Fear functions as part of the broader stress family, alongside worry, anxiety, and catastrophizing. Zoffness emphasizes that these states can change our physiology, amplifying the brain's experience of pain. When pain triggers fear, it activates the amygdala and central nervous system, increasing heart rate, muscle tension, and releasing stress hormones. The amygdala, responsible for emotion and pain, raises the brain's "pain volume" as it enters a state of threat. Catastrophic thinking about pain further fuels this fear response, escalating pain signals and worsening the overall experience.

Crucially, Zoffness points out how understanding pain neuroscience can help. As people learn more about pain and its messages—why it happens, what it means, and what it doesn’t necessarily signify—the threat perception diminishes. This reduction in perceived threat turns down the brain’s pain volume, lessening both intensity and frequency of pain.

Healthy Relationships Ease Pain By Boosting Neurochemicals and Reducing Stress

Prosocial, supportive relationships play a powerful biological role in reducing pain. Zoffness describes healthy relationships as those that are nurturing, respectful, and low in stress. These relationships increase neurochemicals such as serotonin (for mood), [restricted term] (reward), and endorphins (natural opioids). They also relax muscles, lift mood, improve immune function, and overall, decrease pain volume in the brain.

In contrast, toxic relationships—marked by stress, conflict, gaslighting, or estrangement—trigger inflammatory responses and keep the body stuck in a sustained fight-or-flight mode. Muscle tension increases, brain opioid production drops, and immunosuppression sets in. Social isolation or ongoing interpersonal conflict also maintain the threat state and reduce access to the neurochemical supports that protect against pain, making discomfort more intense and persistent. The direct link between social health and physical health is evident: relationships, whether healthy or toxic, shape the body’s ability to process and manage pain.

Optimistic Mindsets Alter Neurobiology to Reduce Pain and Disability

Mindset matters significantly for pain outcomes. According to Zoffness, 70% of studies examining optimism and pain find that hopeful thoughts not only reduce pain intensity, but also lower its frequency and related disability. Optimistic mindsets and self-compassion boost [restricted term], serotonin, and endorphins, again providing a natural defense against pain. This mindset shift moves people from defensiveness to active recovery.

Every thought, Zoffness says, triggers a neurobiological cascade throughout the body, influencing neurotransmitters, hormones, immune cells, and even cardiovascular and musculoskeletal systems. Having an ...

Chronic pain and sleep deprivation are shaped by systemic issues, from inadequate medical training and biases to workplace demands.

Medical Professionals Lack Training in Pain Science, Fueling Myths That Pain Without Biological Markers Isn't Real

Rachel Zoffness points out that chronic pain is complex, but healthcare providers often do not receive sufficient education in pain science. Doctors typically learn to approach pain as a purely biomedical phenomenon, focusing on treating obvious physical symptoms while disregarding or misunderstanding psychological and social factors. When a biological cause for pain cannot be identified, providers often dismiss the pain as psychological, perpetuating the myth that pain must have a visible, medical explanation. This limited training and misunderstanding lead to a trickle-down effect, where people living with pain are left without comprehensive care or understanding of their own conditions. Additionally, providers who feel unequipped to handle complex pain cases often burn out, leading to less empathetic and more dismissive interactions with their patients.

Disparities in Pain Treatment Stem From Historical Misogyny and Racism in Medicine

Disparities in pain treatment are pronounced along lines of race and gender. Shankar Vedantam notes that Black and Latino patients are prescribed pain medications at significantly lower rates than white patients. Rachel Zoffness emphasizes that these longstanding discrepancies remain, affecting both people of color and women. Women are frequently dismissed or marginalized in medical settings and are often told that their pain is psychological or "all in their head." There is a legacy of misogyny in medicine, exemplified by the treatment of heart disease: despite being the leading killer of women, heart disease symptoms in women are frequently attributed to emotional stress or anxiety, resulting in dangerous misdiagnoses or dismissal.

Cultural messaging further complicates these disparities. Men are encouraged to be tough and stoic, with societal language urging them to "man up" and "take it like a man," leading to undertreatment of their pain. However, Zoffness asserts, and research supports, that women endure greater challenges, facing systemic dismissal as unreliable symptom reporters.

Extended Work Schedules Create Sleep Debt, Comp ...

Policy Changes to Schedules Can Reduce Sleep Deprivation and Improve Health and Safety

Chris Barnes emphasizes the abundant research showing that adopting permanent standard time, instead of shifting to daylight saving time, leads to better health and outcomes. He notes that while many prioritize more evening sunlight for social activities like barbecues, they remain unaware of the downsides of daylight saving time. Eliminating daylight saving time is presented as a straightforward policy change that can reduce negative outcomes such as increased car crashes, heart attacks, and workplace injuries that typically follow the shift to daylight saving time.

Another impactful policy is delaying school start times. Barnes explains that early start times, like 7:30 am for high schoolers, are the equivalent of an adult starting work at 4:30 am, directly clashing with teenage circadian rhythms. Movements to push school start times later have gained traction, supporting better sleep and health for adolescents.

Barnes also discusses applying sleep-based scheduling systems from high-responsibility industries—such as transportation and medicine, where rules restrict work hours and regulate shift changes to prevent fatigue-related errors—to other professions. Although not everyone works in environments where errors can be catastrophic, extending similar scheduling principles to more jobs could reduce costly mistakes and improve wellbeing.

Enhance Sleep By Managing Blue Light, Limiting Nighttime Phone Use, and Aligning Tasks With Alertness

On an individual level, Barnes highlights that blue light from phone screens suppresses melatonin production, a hormone critical for sleep. Using phones close to bedtime signals the body to stay awake, reducing sleep quality. Blue light filtering glasses can partially mitigate this problem by blocking the wavelengths most disruptive to the circadian system, though they are not a complete solution.

Barnes recommends self-monitoring of alertness and aligning the day’s tasks accordingly. During periods of low energy or drowsiness, he suggests focusing on routine or simple tasks, such as responding to emails. When feeling more alert and focused, individuals should tackle complex or creative work. This approach ensures people maximize productivity while respecting their natural energy fluctuations.

Chronic Pain Patients Regain Function Through Pacing Protocols That Increase Activity From a Sustainable Baseline, Like Marathon Training

Rachel Zoffness describes pacing as a central pain management strategy where patients identify a beloved activity that pain has taken from them—like playing soccer, dancing, or even baking fudge—and set it as a goal for re-engagement. The first step is to establish a personal baseline: how much activity can be done on a high-pain day and on a low-pain day. Progress begins from the baseline, increasing activity gradually until the goal is met, mirroring marathon training principles.

Pacing allows the brain and body to adapt gradually, improving both physical capacity and the nervous system’s ability to regulate pain. By regaining the ability to participate in meaningful activities, patients take back power from chronic pain, supporting emotional and social reintegration.

Chronic Pain Benefits From Movement, Distraction, Social Connection, Gratitude, and Optimistic Thinking

Listener Jean’s experience aligns with these principles, emphasizing activities that foster recovery. ...