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Sleep in Trans and Non-Binary Individuals: A Question of Gender?
Lieve Thecla van Egmond1,2, Antonia Wilhelm1, Nora Naib Majani1
1Department of Psychiatry and Psychotherapy, Tübingen Centre for Mental Health (TüCMH), University of Tübingen, Tübingen, Germany.
Journal of Sleep Research
|July 18, 2026
Summary
Transgender and non-binary individuals experience high rates of poor sleep and insomnia, significantly exceeding general population benchmarks. Psychosocial factors, not transition options, were key influences on sleep disturbances.
Area of Science:
- Sociology
- Psychology
- Sleep Medicine
Background:
- Sleep problems are a growing concern in society.
- Transgender and non-binary individuals face disproportionate sleep issues due to gender minority stress.
- Limited research exists on sleep in this population, particularly concerning gender-affirming care.
Purpose of the Study:
- To investigate sleep quality and insomnia severity in transgender and non-binary individuals.
- To explore the impact of structural, psychosocial factors, and gender-affirming care on sleep.
- To compare sleep outcomes between different gender identities within the trans and non-binary population.
Main Methods:
- An anonymous, Germany-wide online study was conducted.
- 469 transgender and non-binary individuals participated.
- Standardised questionnaires assessed sleep quality, insomnia severity, and relevant psychosocial and structural factors.
Main Results:
- Poor sleep quality and subclinical insomnia were highly prevalent (2-4 times higher than cisgender benchmarks).
- Non-binary individuals reported worse sleep quality and higher insomnia severity than trans women.
- Psychosocial factors significantly influenced sleep more than structural variables or gender identity; feminizing hormone therapy was associated with lower insomnia severity.
Conclusions:
- Transgender and non-binary individuals exhibit alarming rates of poor sleep and insomnia.
- Further research is needed to understand and address the moderating factors contributing to sleep disturbances in this population.
- Targeted interventions addressing psychosocial factors may be beneficial for improving sleep in transgender and non-binary individuals.
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