Poor sleep affects everything — how you think, how you feel, how you handle stress, and how you function at work and in your relationships. For some people, sleep problems are the first sign that something else is going on.
Why Sleep Disorders Often Have a Psychiatric Root
Sleep and psychiatric health are deeply connected — in ways that go in both directions. Depression commonly causes insomnia or hypersomnia. Anxiety makes it hard to fall asleep or stay asleep. Bipolar disorder disrupts sleep patterns in ways that can trigger or worsen mood episodes. ADHD often involves chronic sleep difficulties that go unrecognized for years.
The connection runs the other way too. Poor sleep worsens depression, amplifies anxiety, and degrades cognitive function — creating a cycle that’s hard to break when only one side gets treated. Getting to the root of a sleep problem often means asking more than just questions about bedtime routines: What’s driving it? What else is going on clinically?
Sleep Disorders I Treat
The most common sleep issue I see is insomnia — difficulty falling asleep, staying asleep, or waking too early. It’s often tied to anxiety, depression, or sustained stress, and in those cases, treating the underlying condition is just as important as treating the sleep itself.
I also work with patients experiencing:
- Hypersomnia — excessive daytime sleepiness that isn’t accounted for by poor nighttime sleep
- Circadian rhythm disruption — sleep timing that’s out of sync with the person’s schedule or daily life
- Sleep-related anxiety — the anticipatory dread of not sleeping that can itself keep insomnia going
- Parasomnias — unusual movements, behaviors, or experiences during sleep, including REM sleep behavior disorder and sleep talking
For patients where sleep apnea or restless leg syndrome is suspected, I coordinate with sleep medicine specialists as needed.
How I Approach Sleep Disorder Treatment
My starting point is understanding what’s actually driving the problem. For most patients, that means a thorough psychiatric evaluation — not just questions about sleep habits, but a careful look at mood, anxiety, substance use, medications, and anything else that might be contributing.
From there, treatment depends on what I find. When insomnia is tied to depression or anxiety, addressing the underlying condition is usually the most direct path to better sleep. I also use Cognitive Behavioral Therapy for Insomnia (CBT-I) — the most evidence-supported non-medication approach, and one that tends to produce more durable results than sleeping pills alone.
When medication is appropriate, I prescribe carefully and with a clear rationale. Sleep aids that work short-term can sometimes create problems over time, and I’d rather not contribute to those.
I’m Dr. David Brendel, MD, PhD — a Harvard-trained, board-certified private psychiatrist in Belmont, MA, with over 25 years in practice. If sleep problems are affecting your health or daily functioning, I’d be glad to meet with you.
Why Choose Dr. Brendel for Sleep Disorder Treatment?
Dr. David Brendel has treated sleep disorders and related psychiatric conditions for over 25 years in private practice in Belmont, MA. A few things that set his approach apart:
- Addresses the full picture — evaluates sleep disorders in the context of depression, anxiety, bipolar disorder, and ADHD, not in isolation
- Harvard-trained with an MD and PhD; board-certified by the American Board of Psychiatry and Neurology
- Expert in CBT-I (Cognitive Behavioral Therapy for Insomnia) — the gold-standard non-medication treatment for chronic insomnia
- Careful prescribing: when medication is appropriate, chooses thoughtfully with an eye on long-term effects, not just short-term relief
- Coordinates with specialists: works with sleep medicine physicians when sleep apnea or complex sleep studies are needed
- Author of Healing Psychiatry (MIT Press) — rigorous academic background applied to individualized, humanistic care
- Located in Belmont, MA, serving Greater Boston, Cambridge, and surrounding communities
- Accepting new patients — book online via ZocDoc or call (617) 932-1548
People often come to me for sleep problems after trying everything — melatonin, sleep hygiene apps, over-the-counter medications, sometimes prescription sleep aids from their primary care doctor. Nothing worked well, or it worked briefly and then stopped.
What I usually find is that the sleep issue isn’t the primary problem. It’s a symptom of something else — depression that hasn’t been adequately identified or treated, anxiety that ramps up the moment the lights go off, a mood pattern that’s been running underneath. When we address that, sleep often improves significantly.
Not always. Some people have chronic insomnia that needs direct treatment on its own terms. In those cases, CBT-I tends to work better than medication alone, and if medication is part of the plan, I’m careful about which one and for how long. Sleep aids that work in the short term can sometimes make things harder down the road, and I try not to contribute to that.
If you’ve been struggling with sleep and haven’t been able to figure out why, that’s exactly the kind of problem I find worth digging into.
Ready to Get Your Sleep Under Control?
Dr. Brendel is accepting new patients in Belmont, MA — seeing patients dealing with insomnia, sleep disruption, and related conditions from across Greater Boston. If sleep problems are affecting your health and daily life, getting a clear evaluation is the right place to start.