In this study, we developed a flexible, biocompatible, and high-output electrical performance triboelectric nanogenerator (TENG) employing a silk fibroin (SF)-MXene composite film (SF-MXene-F) and a PDMS film as the friction layer. The inclusion of MXene in the SF film increased its surface charge density, presenting a practical approach to designing high-performance SF composite film-based TENGs. At a MXene content of 40%, our SF-MXene composite film-based TENG (SF-MXene-FTENG) achieved optimal output electrical performance, featuring a maximum open-circuit voltage (Voc) of 418 V, a maximum short-circuit current (Isc) of 11.6 μA, and a maximum output power density of 9.92 W/m2. The Voc and power densities of the SF-MXene-FTENG surpassed previously reported optimal values for SF-based TENGs by 1.6 and 3.8 times, respectively. Furthermore, leveraging the exceptional biocompatibility and light shading performance of TENGs, we designed a wearable smart TENG eye mask capable of diagnosing insomnia symptoms and monitoring sleep quality in real time. The SF-MXene-FTENG holds promising application potential as a wearable electronic device for diagnosing sleep-related diseases.