Sleep is one of those things you only miss once it is gone. In the clinics that care for trans and non-binary people, however, it is rarely asked about. A team from the University of Vienna and the University Hospital of Tübingen decided to measure it with data: they launched an anonymous questionnaire across Germany and gathered responses from 469 trans and non-binary people. The result, published in Journal of Sleep Research, is that poor sleep quality and subclinical insomnia show up two to four times more often than in published benchmarks for the cisgender population.
The study is cross-sectional: a snapshot taken at one moment in time, not a longitudinal follow-up. Participants, recruited online, answered standardised questionnaires on sleep quality and insomnia severity, plus a block of questions on structural factors —access to healthcare, administrative barriers, violence or rejection in the environment— and psychosocial ones, including minority stress, the added burden that comes with belonging to a stigmatised group. There was no clinical sleep diagnosis and no objective measurement: everything analysed is what each person reports about how they sleep.
The numbers are hard to ignore. More than 30% of respondents had frequent sleep maintenance problems, that is, repeated awakenings that break rest. Subclinical insomnia —clear sleep problems that do not yet meet every diagnostic criterion— and poor sleep quality were the rule rather than the exception. And there were differences within the group itself: non-binary people scored worse on sleep quality and insomnia severity than trans women.
One of the most interesting findings concerns which of the factors analysed best explained those differences. The authors compared structural variables, gender identity on its own, and psychosocial factors: the latter explained substantially more variance than the other two. In other words, it is not identity itself that breaks sleep, but the conditions in which that identity is lived. The same pattern appeared when looking at transition steps: whether or not people had accessed different transition options did not significantly change sleep quality or insomnia severity.
Hormone therapy, by contrast, did show a relationship. People using feminising treatment had less severe insomnia scores than those not using it. The authors present this as an association within a cross-sectional study: it cannot show that hormone therapy improves sleep, only that in this sample the two appear together. The distribution of problems was not identical between groups either: trans women woke up significantly more often because of nocturia, the need to urinate at night, while trans men and non-binary people had more trouble falling asleep. Non-binary people also used sleep medication more often than binary trans people.
Why does this matter in a clinic? Because sleep is not a luxury: it is part of the system that sustains mood, stress regulation and part of metabolism. Long-standing insomnia raises the risk of depression and anxiety, two conditions already more frequent in the trans population, and broken rest also makes it harder to keep up with treatment or attend appointments. Asking about sleep is cheap; not asking leaves out a problem that, according to these data, affects most of the people who come for care.
The limitations call for caution. The sample is German, recruited online and self-selected: people who sleep badly have more reason to answer a survey about sleep, which may inflate the figures. It is a cross-sectional study, so it cannot establish what causes what. And there is no clinical diagnosis or objective measure of rest. What the work does support is the size and consistency of the gap compared with the cisgender population, and the fact that the weight falls on modifiable factors: less stigma, better access and more questions in the consulting room. Sleeping well does not resolve gender incongruence, but sleeping badly makes it far harder to bear.
Source: Sleep in Trans and Non-Binary Individuals: A Question of Gender? van Egmond LT, Wilhelm A, Majani NN, Derntl B. Journal of Sleep Research 2026;e70402. DOI: 10.1111/jsr.70402.
Article published at dosier.es. Image generated with artificial intelligence (marta ai → marta.syf.es).
