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Understanding Sleep Problems in the LGBTQ Community

Quick Overview

Sadly, discrimination, stigma, and family rejection are all common experiences for individuals of the LGBTQ community. The prejudice and harassment these individuals face can lead to social isolation, mental health issues, and sleep problems.

Individuals with minority sexual or gender identities are significantly more likely to have trouble falling asleep and staying asleep. As a result, they’re more likely to live in a state of sleep deprivation, which makes it harder for them to cope emotionally and reduces their overall well-being.

We review the current research around sleep and the LGBTQ community, explore the potential causes and risk factors, and provide tips for sleeping better.

Note: in the studies we cite below, researchers will refer to LGBTQ individuals in different ways. To account for as wide a range of sexual orientations as possible, it is common for studies to have various distinctions into which participants are categorized (such as “gay,” “mostly gay,” “straight,” and “mostly straight,” in one example).

The study authors’ intent is to better reflect actual experiences, versus strictly confining individuals to “gay” or “straight.” Throughout this article, the language we use reflects that used by the authors of the study we’re discussing.

Sleep Issues Common to the LGBTQ Community

Sleep Disturbances in the LGBTQ Community

Generally, individuals with a minority sexual orientation have a higher risk of sleep disturbances than their heterosexual peers. Typically, these include:

  • Difficulty falling asleep several times a week
  • Difficulty staying asleep throughout the night
  • Short sleep, i.e. six or fewer hours of sleep per night (the majority of adults need at least 7 to 7.5 hours of nightly sleep to feel and perform at their best)

The above are all symptoms of insomnia. At any given point, up to 20 percent of the population experiences temporary insomnia. For these individuals, symptoms persist for a few days to weeks, and can often be tied back to a specific event or circumstance, such as work stress, illness, travel, or a personal loss.

When these symptoms persist for weeks to months, and the individual experiences them for at least three nights out of the week, the insomnia is considered chronic. Chronic insomnia is more rare, affecting about 10 percent of the population.

Insomnia

Insomnia is not as rare among the LGBTQ community, though, according to the research. One 2017 study of nearly 15,000 adults aged 24 to 32 years old found the following:

  • Difficulty falling asleep was more prevalent among women who identified as bisexual, being attracted to both sexes, or having “mostly opposite sex” partners; and among men who had “mostly same sex” partners.
  • Difficulty staying asleep was most commonly reported among women who identified as bisexual, having had “mostly opposite sex partners,” or being attracted to “both sexes”; as well as among men who were attracted to “both sexes.”
  • Short sleep was common among various identities, including women who identified as “mostly straight” or “mostly gay,” were attracted to only “same sex” individuals, and who had had “mostly same sex” partners; as well as among men who identified as “bisexual or being attracted to both sexes.”

In addition to the classic insomnia symptoms cited above, another study observed a higher tendency among LGBTQ individuals to take medication to help them fall and stay asleep on a regular basis (4 times or more per week). The study found that gay men were nearly three times more likely (14.7 percent vs. 5.6 percent) to do this than their straight counterparts. Gay and lesbian women were also more likely, although to a lesser extent.

Sleep Deprivation

Over time, when insomnia symptoms are experienced on a chronic basis, the result is sleep deprivation. Even just one night of short sleep can impair your mood and functioning the following day, increasing your irritability, slowing your reaction time, and worsening your judgment.

In the long-term, sleep deprivation has been linked to increased risk of type 2 diabetes, cardiovascular disease, obesity, and cancer. Unfortunately, these same health conditions were found in a group of sleep-deprived LGBT adults.

The study, which relied on data from 146,893 adults, categorized respondents by sexuality (cisgender straight, lesbian, gay, bisexual, transgender) and sleep duration. Here’s what the researchers found:

  • LGBT respondents were much more likely to experience very short sleep (defined as 5 hours or less) than their cisgender straight counterparts (17.3 percent vs. 12.2 percent).
  • There was much variety among different sexual minorities and gender identifies, in terms of how much short sleep they lost. Those most at-risk were transgender/gender-nonconforming individuals, among whom 35.5 percent experienced very short sleep.
  • Independent of their specific identity, the LGBT respondents with very short sleep were significantly more likely to have stroke (a four times increased risk); heart attack or coronary heart disease (three times increased risk); or asthma, chronic obstructive pulmonary disease, arthritis, and cancer (between 1.5 to 2.5 times increased risk).

Why Sleep Loss is High in the LGBTQ Community

Researchers have put forward several explanations for what’s behind the sleep issues LGBTQ individuals experience. As you’ll see below, many of these factors, like bullying and depression, go hand in hand with poor sleep. Worse, the less sleep the individual gets, the less equipped they are to cope with the underlying issue.

Bullying

Bullying is highly correlated with disrupted sleep and other conditions like depression which, in turn, negatively impact sleep. LGBTQ individuals are significantly more likely to experience bullying, with 70 percent having been bullied at school.

In 2018, the Human Rights Campaign (HRC) Foundation conducted an online survey of 12,000 teenagers aged 13 to 17. Around 75 percent of the teens reported receiving verbal threats due to their sexual identity. About half of transgender teens reported being unable to use the school bathrooms that matched their gender identity, out of fear for their safety. Overall, only a quarter of the teens felt safe at school.

Perhaps unsurprisingly, at 95 percent, nearly all of the respondents had sleep issues. Sleep problems, particularly difficulty sleeping and nightmares, are common symptoms for bullying victims. Additional bullying symptoms — which are independently comorbid with sleep issues themselves — include depression, anxiety, changes in weight, smoking, and suicidality and self-harm.

Anxiety and Depression

Anxiety is one of the most common causes of insomnia. Anxiety has also been implicated in the insomnia associated with heavy social media use, the platforms where many LGBTQ individuals experience cyberbullying.

Depression is also much more prevalent among the LGBTQ population. A 2018 study found that sexual minority young adults were consistently more likely to experience depressive symptoms than sexual majority adolescents. Researchers determined that cyberbullying, low family satisfaction, and unmet medical needs were the factors most likely to create these results.

depressive symptoms more common among sexual minority young adults vs heterosexual

Source: Pediatrics

Depression is highly correlated with insomnia, as well as its opposite: hypersomnia (a tendency to oversleep and still not feel adequately rested, despite sleeping even more).

Mental Health Issues

In general, sexual minority adults are more likely to have mental illness than sexual majority adults:

mental illness more common among sexual minorities

Source: SAMHSA

When serious mental illness is considered, the gap widens even more:

serious mental illness more common among lgbtq adults

Source: SAMHSA

Sleep issues are so prevalent among patients with mental illness that fewer than 20 percent don’t have sleep problems.

Mental health issues, like depressive symptoms, stress, smoking, binge drinking, and victimization are commonly experienced by the LGBTQ community at greater rates than others. Problematically, sleep deprivation can be a risk factor for increased mental health issues, which in turn further disrupts sleep.

A meta-analysis found that suicidality is nearly three times more common among those with a minority sexual orientation. Among bisexual youth, that “more likely” number jumps to 500 percent. Transgender youth are particularly at risk, with a two to three times higher prevalance of depression, anxiety, and suicide attempts.

Fear and trauma, such as that caused by the physical threats or assaults experienced by bullying victims, can develop into post-traumatic stress disorder (PTSD). Common sleep issues for PTSD include nightmares and insomnia.

For many in the LGBTQ community, sleep problems can start in early childhood. For example, transgender children have a severalfold higher risk of ADHD. About three-quarters of children with ADHD have sleep problems, including daytime sleepiness and sleep-disordered breathing.

Stress at Home

When it comes to mental health issues, perhaps none is more common than stress. Increased levels of stress, particularly in regards to family relationships, appear to be a major mediating factor in sleep issues among LGBT and sexual minority adults, according to one recent study.

This study, like the others we’ve referenced, found that LGBTQ individuals tend to have more sleep issues (especially difficulty falling and staying asleep) than their straight peers. More specifically, however, the researchers noted that the social rejection these individuals experienced from their families was a significant cause of that stress and subsequent insomnia.

Theoretically, it makes sense that stress makes it harder to sleep. Sleep requires relaxation, and stress makes it tough to relax. But, stress actually affects your sleep at a hormonal level. When your stress hormones are high, your sleep hormones are low. Stress is widely associated with insomnia and sleep difficulties, including a longer sleep latency (the time it takes you to fall asleep) and fragmented sleep.

For many LGBTQ teens, home isn’t a safe environment. According to the HRC survey, 76 percent have not come out to their families. Three-quarters of these teens have heard their families “make negative comments about LGBTQ people.”

Transgender youth are twice as likely to be mocked by their family for their LGBTQ identity than their cisgender peers. Between 80 to 91 percent of teens, depending on their sexual and gender identity, reported their average stress level being at least a 5 on a scale of 1 to 10.

Identity Risk Groups

Finally, different genders and sexual identities — or lack thereof — are associated with increased sleep issues. Almost all the studies found that sexual minority women are at a greater risk for sleep disturbances than sexual minority men, a finding that correlates with women’s increased risk for insomnia overall.

Moreover, one study found that women with minority sexual orientations were at particular risk for related mental health issues like depression, stress, and substance abuse. The women experienced these symptoms at even higher rates if they identified as being “mostly straight,” “bisexual,” attracted to both sexes, or having “mostly opposite sex” partners.

Other studies have noted a correlation between certain sexual orientations and gender identities and increased risk of sleep problems. Specifically, the individuals who don’t fall into a clear “box” regarding their gender or sexual orientation tend to experience worse sleep.

For example, the large-scale study of nearly 15,000 participants found that both women and men who identified as “mostly straight” were more likely than those who identified as “straight” to experience sleep problems. Other groups most at risk of sleep disturbances included:

  • Men and women who identified as “bisexual,” or attracted to “both sexes”
  • Women who identified as “mostly gay,” or who had had “mostly opposite sex partners”
  • Men who had had “mostly same sex partners”

Researchers noted that these all fall into “intermediate categories of sexual orientation.” By that, they’re suggesting that these individuals may have not yet settled on a specific sexual identity, or, they feel that their own sexual identity does not fit neatly into one of the defined societal categories. These researchers also warned that these individuals are the most at-risk for health problems (even those beyond sleep).

This is a finding which was confirmed by an earlier 2012 study, which noted increased instances of depressive symptoms, stress levels, smoking and binge drinking among individuals who identified as bisexual or “mostly” straight or gay. The increased health risks also apply to those with a gender identity that falls outside of society’s currently limited definitions.

In the study we referenced above focusing on short sleep, the tendency for very short sleep — and the associated health issues — was much more prevalent among gender-nonconforming individuals.

Helping the LGBTQ Community Get Better Sleep

Physical, mental, and social well being all predict how well one can sleep at night. Likewise, with healthier sleep, LGBTQ individuals are better equipped to deal with the unique challenges facing their community. Below, we share our best tips for enjoying better sleep.

1. Practice good sleep hygiene.

Sleep hygiene is a set of practices that promote sleep, rather than hinder it. Many of us don’t realize how our everyday behaviors can negatively impact our sleep.

Start by going to bed and wake up at the same time every day, even weekends. Resist the temptation to sleep in. By training your brain to a strict sleep schedule, your body will naturally tire and feel energized at the same time each day, making it easier for you to get sufficient sleep on a regular basis. Make sure your bed- and wake-up times include enough room in between for you to conceivably get at least 7 hours of sleep.

2. Follow a bedtime routine.

One popular sleep hygiene practice is to follow a bedtime routine. The idea is that by following the same set of activities before you go to sleep each night, your brain comes to associate those activities with sleep. For individuals experiencing the stress, anxiety, and depression common to the LGBTQ community, a bedtime routine is an opportunity for self-love and self-care.

Use the 30 minutes before bed to meditate, practice yoga, write in a diary, color in an adult coloring book, read, or take a bath.

3. Limit screen time.

One thing your bedtime routine should not include? “Winding down” on Facebook or Netflix. Electronics flood your eyes with bright blue light, activating your mind and tricking your brain into thinking it’s daytime, so it works to keep you awake when you’re trying to fall asleep. Coincidentally, these are the same devices we use to access social media, where cyberbullying can happen.

Nighttime social media use is linked with a 1.5 times increased risk of disturbed sleep.

4. Makeover your bedroom.

Keep your bedroom cool, dark, and quiet. These are the prime conditions for restful sleep. Remove clutter and any stressful triggers from the bedroom, such as reminders of work, school, or strained family relationships. Make sure your mattress and bedding are supportive and comfortable. Consider a weighted blanket for additional comfort.

5. Improve your diet.

What you eat affects how you feel, and how well you sleep. Avoid eating large meals and anything spicy for dinner. Stay off the caffeine, alcohol, and other substances past the early afternoon. Instead, snack on healthy, sleep-promoting foods that are easy on the digestive system, like bananas, legumes, nuts, and fish.

6. Explore psychotherapy.

Psychotherapy can be helpful for treating many of the underlying issues that cause sleep problems, like depression, anxiety, ADHD, and others. CBT, or cognitive behavioral therapy, can be particularly effective. This therapy focuses on helping the individual recognize the negative thoughts, reactions, and behaviors they default to.

Then, the individual works with their therapist to learn how to replace them with healthier responses. CBT-I is one subset of CBT that focuses on insomnia, specifically.

Therapists can develop a treatment plan that addresses sleep issues along with other issues. To find a therapist, reference the LGBTQ-friendly provider directories offered by The Association for Lesbian, Gay, Biseual and Transgender Issues in Counseling, The Gay and Lesbian Medical Association, and The Association of LGBTQ Psychiatrists.

7. Create a strong support system.

Strained family relationships, bullying from peers, and lack of familial and social support were all associated with sleep problems in the LGBTQ community. Even independently, loneliness has been linked to insomnia. Having a minority sexual identity can be isolating, particularly if you don’t have support from your immediate family.

Reach out to extended family and friends whom you can trust to support you. LGBTQ individuals can also find support groups, mental health counselors, and peer mentors through organizations like LGBT National Help Center, The Trevor Project, and National Center for Transgender Equality.

Final Thoughts

Sleep issues are relatively common among the LGBTQ population. Often, these include difficulty falling or staying asleep, lack of sufficient sleep overall, and the resulting symptoms of sleep deprivation.

Individuals can be at increased risk of these sleep problems if they have a comorbid mental health disorder, are victimized at home or at school, or have gender identities or sexual orientations that don’t match the current definitions offered by society.

This is a community that experiences stigma at a higher rate than others, and unfortunately, there’s a lack of resources to support them. However, awareness and concern over these issues is growing, bolstered by academic research.

If you or someone you know identifies with this community and is experiencing sleep issues, there are options. Individuals can start by implementing better sleep hygiene, following a restorative bedtime routine, and leaning on friends and chosen family for support.

There are also counselors and mental health professionals trained in resolving the sleep, emotional, and broader health issues unique to LGBTQ individuals. Alternately, many non-psychotherapeutic techniques can improve both mental health and sleep, including meditation, yoga, progressive muscle relaxation, and guided imagery.

Additional Tuck Resources

At the links below, you can learn more about mental health and sleep, or find LGBTQ resources and support in your local community.

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