Key Messages

• • Sleep health is about both how long and how well your child sleeps

• • Most teenagers need around 8-10 hours of sleep each night

• • Research suggests trans young people are more likely to experience insomnia, daytime sleepiness, and other sleep difficulties than their cisgender peers^{1 2 3}

• • Stress from stigma, bullying, anxiety, dysphoria, trauma, and feeling unsafe can make sleep much harder⁴

• • Family support, affirming environments, and access to gender-affirming care may help protect sleep and well-being^{1 5}

• • Consistent routines, calming bedtime habits, and support for underlying stress can make a real difference

What is Sleep Health?

Sleep health is more than just hours in bed. It also includes how easily a young person falls asleep, how often they wake during the night, and how rested they feel in the morning. Most teenagers need around 8-10 hours of sleep each night.

It is common for teenagers to start feeling sleepy later at night during puberty. This is partly because the body clock naturally shifts later in adolescence. However, if your child regularly takes a long time to fall asleep, wakes often, sleeps for only a short time, or still feels exhausted after a full night in bed, this may suggest a sleep problem.

Common sleep difficulties in young people include:

• • Insomnia – consistent trouble falling asleep or staying asleep

• • Delayed sleep phase (the body clock shifts later than desired)

• • Sleep apnoea, which involves breathing problems during sleep

• • Restless legs syndrome

• • Nightmares or trauma-related sleep disruption
    Sleep problems can affect:

• • Mood, including anxiety, irritability, and low mood

• • Concentration and memory

• • School attendance and learning

• • Daytime energy and sleepiness

• • Safety, including falling asleep in class or when travelling

How common are sleep problems in trans young people?

Research suggests trans young people are much more likely to experience sleep difficulties than their cisgender peers.^{1 2 4} One large study found that trans young people were around 5 times more likely to experience insomnia and around 3 times more likely to experience other sleep disorders.¹

Why are trans young people at higher risk?

There is no single cause. Sleep is shaped by a mix of body rhythms, emotional well-being, safety, routine, environment, and stress. Trans young people may face extra stressors and barriers that make sleep more difficult.

Minority stress and discrimination

Trans young people may experience bullying, discrimination, invalidation, or pressure to hide who they are. These experiences can make it much harder for the body and mind to settle enough for sleep. Minority stress is linked to trouble falling asleep and poorer sleep quality. ⁴ Trauma can affect sleep through nightmares, hypervigilance, and difficulty feeling safe enough to fully relax. This is one reason trauma-informed support can be so important.

Anxiety, dysphoria, and rumination

Sleep can be especially hard when a young person is lying awake worrying. Anxiety about safety, acceptance, school, or their body can keep the mind active at night. Gender dysphoria may also make bedtime harder, especially if clothing, body sensations, or being alone with one’s thoughts increase distress.

Family conflict or lack of support

Young people sleep better when they feel safe, supported, and accepted at home. Family rejection or conflict can leave a young person feeling on edge, which can interfere with sleep. Family warmth and acceptance are linked to better well-being, including better sleep.⁵

School stress and unsafe environments

School can affect sleep substantially. Worrying about bullying, changing rooms, bathrooms, teachers, or peer reactions can keep a young person in a state of ongoing stress. Negative school environments are associated with poorer sleep in trans young people.³

Neurodivergence and sensory needs

Neurodivergent trans young people may have additional sleep challenges linked to sensory sensitivity, difficulty winding down, inconsistent routines, or differences in arousal regulation. Research in Autistic young people suggests that structured behavioural sleep supports and attention to sensory needs can help.⁶

Medical and practical barriers

Difficulty accessing gender-affirming medical care can increase stress and uncertainty, which may affect sleep. Some medications may also affect sleep. For example, there are case reports suggesting testosterone may worsen or trigger sleep apnoea in some people, so new snoring or breathing problems should be checked by a doctor.⁸

What helps?

Sleep support is usually most effective when it addresses both the sleep routine itself and the things making it hard for the young person to feel calm and safe enough to sleep.

• • Consistent routines: A regular bedtime and wake time can help reset the body clock. This is often one of the most effective starting points. It can help to keep wake time fairly consistent, even on weekends.

• • Calming bedtime habits: A predictable wind-down routine can help signal that it is time for sleep. This might include dimming lights, reading, listening to calming music, gentle stretching, or other quiet activities. For some young people, especially Autistic young people, sensory adjustments such as white noise, softer clothing, weighted blankets, or a darker room may also help.⁶

• • Reducing screens and stimulants: Phones, tablets, and other screens can make it harder to fall asleep, especially when used close to bedtime. Caffeine can also interfere with sleep for many hours after it is consumed. Limiting screen use before bed and avoiding caffeine later in the day can help.

• • Anxiety management: If a young person’s mind is busy at night, it can help to create space to talk earlier in the evening rather than right at bedtime. Relaxation strategies such as deep breathing, mindfulness, or gentle muscle relaxation may also help reduce racing thoughts.

• • Cognitive Behavioural Therapy for Insomnia: CBT for insomnia, often called CBT-I, has good evidence for adolescents with insomnia. It can help with sleep habits, anxious thinking, and patterns that keep insomnia going.⁹ This is often most useful when guided by a clinician, but some of its ideas can also be used at home.

• • Positive reinforcement and structure: For some young people, especially Autistic young people, behavioural sleep supports work best when routines are clear, predictable, and positively reinforced. Research suggests structured behavioural programmes can improve sleep duration and bedtime routines.¹⁰

• • Gender affirmation: Feeling affirmed and safe can make sleep easier. Using your child’s chosen name and pronouns, supporting gender expression, and helping reduce dysphoria where possible may support emotional safety and well-being. Some research also suggests that access to gender-affirming care may reduce the likelihood of sleep disorders for some trans young people.¹

What parents and carers can do

You don’t need to fix everything at once. Small, steady supports matter.

• • Take sleep problems seriously: Sleep difficulties are real and can have major effects on mood, concentration, and day-to-day functioning.

• • Look for what might be getting in the way: This could include anxiety, bullying, dysphoria, sensory discomfort, trauma, inconsistent routines, or too much screen time at night.

• • Build a calm and predictable wind-down routine: Aim for the same broad pattern each night, with quiet and comforting activities before bed.

• • Support sensory comfort: Notice whether light, sound, clothing, temperature, bedding, or body sensations are making sleep harder.

• • Keep communication open: If your child seems worried at night, try making space earlier in the day to talk about what is on their mind.

• • Support gender affirmation: Small things like names, pronouns, clothing, and feeling safe at home can matter more than they may seem.

• • Seek help early if problems are ongoing: If sleep is affecting school, mood, or safety, it is worth getting support rather than waiting for it to resolve on its own.

References

1. 1. Gavidia, R., Whitney, D. G., Hershner, S., Selkie, E. M., Tauman, R., & Dunietz, G. L. (2022). Gender identity and transition: Relationships with sleep disorders in US youth. Journal of Clinical Sleep Medicine, 18(11), 2553–2559. https://doi.org/10.5664/jcsm.10158

1. 1. Levenson, J. C., Thoma, B. C., Hamilton, J. L., Choukas-Bradley, S., & Salk, R. H. (2021). Sleep among gender minority adolescents. Sleep, 44(3), zsaa185. https://doi.org/10.1093/sleep/zsaa185

1. 1. Ricklefs, C., Balasubramanian, P., Ganson, K. T., Testa, A., Kiss, O., Baker, F. C., & Nagata, J. M. (2025). Gender Identity Disparities in Early Adolescent Sleep: Findings from the Adolescent Brain Cognitive Development Study. LGBT Health, 12(3), 231–236. https://doi.org/10.1089/lgbt.2023.0431

1. 1. Martin-Storey, A., Mayne, K., Beischel, W., & Craig, W. (2024). Sleep health among youth outside of the gender binary: Findings from a national Canadian sample. Sleep Health, 10(6), 621–627. https://doi.org/10.1016/j.sleh.2024.07.010

1. 1. Katz-Wise, S. L., Rosario, M., & Tsappis, M. (2016). Lesbian, Gay, Bisexual, and Transgender Youth and Family Acceptance. Pediatric Clinics of North America, 63(6), 1011–1025. https://doi.org/10.1016/j.pcl.2016.07.005

1. 1. Lane, S. J., Leão, M. A., & Spielmann, V. (2022). Sleep, Sensory Integration/Processing, and Autism: A Scoping Review. Frontiers in Psychology, 13, 877527. https://doi.org/10.3389/fpsyg.2022.877527

1. 1. Robertson, B. D., Lerner, B. S., Collen, J. F., & Smith, P. R. (2019). The Effects of Transgender Hormone Therapy on Sleep and Breathing: A Case Series. Journal of Clinical Sleep Medicine, 15(10), 1529–1533. https://doi.org/10.5664/jcsm.7992

1. 1. Robertson, B. D., Lerner, B. S., Collen, J. F., & Smith, P. R. (2019). The Effects of Transgender Hormone Therapy on Sleep and Breathing: A Case Series. Journal of Clinical Sleep Medicine, 15(10), 1529–1533. https://doi.org/10.5664/jcsm.7992

1. 1. Mei, Z., Cai, C., Luo, S., Zhang, Y., Lam, C., & Luo, S. (2024). The efficacy of cognitive behavioral therapy for insomnia in adolescents: A systematic review and meta-analysis of randomized controlled trials. Frontiers in Public Health, 12, 1413694. https://doi.org/10.3389/fpubh.2024.1413694

1. 1. Griggs, S., Conley, S., Batten, J., & Grey, M. (2020). A systematic review and meta-analysis of behavioral sleep interventions for adolescents and emerging adults. Sleep Medicine Reviews, 54, 101356. https://doi.org/10.1016/j.smrv.2020.101356