In education, I know what keeps me awake at night.
I would imagine that each professional in their chosen career, when asked, could identify the thing that keeps them up at night. For the day trader, it might be an unexpected stock market crash. The comedian could lie awake in fear of an empty auditorium. Restless nights may come to the dentist who lays awake thinking of drilling the wrong tooth, or the professional athlete who misses the field goal to miss the playoffs.
There is a universal truth when starting any sort of new project, vision, implementation, or system change: a disruption and reallocation of time and resources must be addressed. With the addition of a new goal, there will be a back and forth battle as finite (time, staffing, money) resources are reassigned. To minimize or alleviate the exhaustion that accompanies the tug-of-war, alignment should be the goal of every leader.