Why Sleep Is Psychiatry's Blind Spot—And How to Fix It with Avinesh Bhar, MD
Wed Jan 21 2026
Most of Brittany Albright's treatment-resistant depression patients test positive for obstructive sleep apnea. Some longstanding ADHD cases turn out to be sleep apnea too—treated, the diagnosis comes off. Dr. Avinesh Bhar, a sleep medicine physician who founded Sliiip, joins Will Sauvé and Brittany Albright to discuss why sleep disorders hide behind psychiatric diagnoses. They cover how sleep apnea now shows up earlier and in different presentations, why women get missed on standard scoring, and what the 2-3am wake-up really means. The conversation also addresses the access crisis—only 150 sleep fellows graduate annually—and how telemedicine and home testing are starting to close the gap.
Timestamped Show Notes:
[00:00:00] Introduction: Dr. Bhar's path from pulmonology to sleep medicine [02:19] Sleep as a "single-player experience" and why patients normalize dysfunction
[06:18] Psychiatry training teaches us to avoid deep sleep conversations
[07:09] Only 150 sleep physicians graduate annually; most were grandfathered in
[08:08] "The test is negative, now what?" The Seroquel referral loop
[09:22] Tardive dyskinesia case from quetiapine prescribed for sleep
[11:58] Financial conflicts in sleep medicine: in-lab vs. home testing
[14:05] Setting up virtual sleep medicine for accessibility
[16:44] Dr. Albright on 9-12 month waitlists and finding Dr. Bhar
[19:04] The deprescribing challenge: when patients don't want to stop meds
[21:43] Multi-night home testing vs. single-night in-lab studies
[22:53] Skulls at smallest size in evolution; REM-dependent sleep apnea in women
[24:06] The 2-3 AM wake-up: tracing the third REM cycle
[26:15] "Is insomnia a diagnosis or symptom?"
[27:01] Teeth grinding as a sign of sleep-disordered breathing
[28:13] Sleep apnea and addiction: the stimulant-alcohol cycle
[29:02] AI scoring trained on male patients; women get missed
[31:32] PTSD, metabolic syndrome, and sleep apnea overlap
[32:08] GLP-1s as "cheat code" for insurance approval
[34:07] Weight loss doesn't cure sleep apnea permanently
[35:38] Patients don't know what "well" feels like
[36:20] ADHD diagnosis removal after sleep apnea treatment
[38:09] Teenagers on stimulants: changing long-term trajectories
[38:54] Magic wand question: insomnia as diagnosis vs. symptom
[40:04] CBTI resources: the VA's free app
[43:45] Wearables: useful for trends, not diagnosis
Brought to you by: Osmind.org, the #1 All-in-one Billing Solution + EHR for the modern private psychiatry practice
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Most of Brittany Albright's treatment-resistant depression patients test positive for obstructive sleep apnea. Some longstanding ADHD cases turn out to be sleep apnea too—treated, the diagnosis comes off. Dr. Avinesh Bhar, a sleep medicine physician who founded Sliiip, joins Will Sauvé and Brittany Albright to discuss why sleep disorders hide behind psychiatric diagnoses. They cover how sleep apnea now shows up earlier and in different presentations, why women get missed on standard scoring, and what the 2-3am wake-up really means. The conversation also addresses the access crisis—only 150 sleep fellows graduate annually—and how telemedicine and home testing are starting to close the gap. Timestamped Show Notes: [00:00:00] Introduction: Dr. Bhar's path from pulmonology to sleep medicine [02:19] Sleep as a "single-player experience" and why patients normalize dysfunction [06:18] Psychiatry training teaches us to avoid deep sleep conversations [07:09] Only 150 sleep physicians graduate annually; most were grandfathered in [08:08] "The test is negative, now what?" The Seroquel referral loop [09:22] Tardive dyskinesia case from quetiapine prescribed for sleep [11:58] Financial conflicts in sleep medicine: in-lab vs. home testing [14:05] Setting up virtual sleep medicine for accessibility [16:44] Dr. Albright on 9-12 month waitlists and finding Dr. Bhar [19:04] The deprescribing challenge: when patients don't want to stop meds [21:43] Multi-night home testing vs. single-night in-lab studies [22:53] Skulls at smallest size in evolution; REM-dependent sleep apnea in women [24:06] The 2-3 AM wake-up: tracing the third REM cycle [26:15] "Is insomnia a diagnosis or symptom?" [27:01] Teeth grinding as a sign of sleep-disordered breathing [28:13] Sleep apnea and addiction: the stimulant-alcohol cycle [29:02] AI scoring trained on male patients; women get missed [31:32] PTSD, metabolic syndrome, and sleep apnea overlap [32:08] GLP-1s as "cheat code" for insurance approval [34:07] Weight loss doesn't cure sleep apnea permanently [35:38] Patients don't know what "well" feels like [36:20] ADHD diagnosis removal after sleep apnea treatment [38:09] Teenagers on stimulants: changing long-term trajectories [38:54] Magic wand question: insomnia as diagnosis vs. symptom [40:04] CBTI resources: the VA's free app [43:45] Wearables: useful for trends, not diagnosis Brought to you by: Osmind.org, the #1 All-in-one Billing Solution + EHR for the modern private psychiatry practice