I often wake up in the middle of the night with intense gender dysphoria. I feel that I have finally started to accept myself as a transwoman, yet I have done very little physically to change myself. Does anyone else have/had this problem? Was or is there anything that has helped? I'm trying to see what the minimum amount of physical changes are needed for me to feel OK. As a result I'm going very very slow physically, possibly slower than my mind and I'm wondering if this could be part of my problem.

Definitely! I had severe sleep problems due to Dysphoria and the doctors tried literally everything. Ambien, Lunesta, Trazedone, Valium, A few others whose names I don't remember and even Chloral Hydrate. Nothing worked. Well, the Chloral Hydrate, but it wasn't fun. I was going to Therapy dressed and feminized to the max one day to try it not knowing it would be so enjoyable I went full time the same day. That night I did not change and went to bed with long nails, breast forms, shaved body, nightgown, etc. I fell asleep very fast and slept a full 10 hours that night. My body could not rest because it felt off as a male. So yes, Dysphoria can cause a lack of sleep and feminization CAN help. Now the only problem with sleeping is debating which gown to wear to bed! 

I fantasize of my next outing and how I will dress and where I will go.
There us when i stay up without been able to sleep.