If a child is struggling to breathe, is floppy or will not wake, or their skin, lips or tongue look blue or grey: call 999 now. Colour changes are harder to see on brown and black skin, so check the palms, soles, lips and tongue. If you are worried but it is not an emergency, call NHS 111. In Northern Ireland use your GP out-of-hours service.

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Why sleep can be different

The five routes by which sleep gets disrupted, and what to rule out first.

The short version

  • Loud regular snoring, choking, or appearing to stop breathing in sleep needs a specialist referral. Ask directly whether your child needs one.
  • Your child cannot rather than will not settle. It is not a conscious process, and comforting them has not created a problem.
  • Five routes disrupt sleep: physical health, anxiety and mood, body clock, sensory processing, and how settling was learned. Each one can be worked on.
  • Ask a clinician to rule out physical causes first: pain, reflux, constipation, night-time seizures, ear or tooth pain, eczema, and every medicine.
  • Keep a two-week sleep diary. Recording bedtime and time asleep separately shows whether it is a settling problem or a waking one.

The rest of this page explains where this comes from. You do not have to read it tonight.

About 5 minutes to read

Why sleep can be different

Cerebra's free Sleep: A Guide for Parents (version 4, October 2025) sets out five routes by which sleep gets disrupted. Most children have more than one.

Five pathways to disturbed sleep Five labelled boxes, physical health, anxiety and mood, body clock, sensory processing and settling associations, each with an arrow pointing down into a single wider box labelled disturbed sleep. Physicalhealth, pain,breathing Anxiety, fearof the dark,medication Body clockand sleephormones Sensoryprocessingdifferences How settlingback to sleepis learned Disturbed sleep Usually more than one pathway at once. Each one can be worked on. After Cerebra, Sleep: A Guide for Parents (2025)
A sleep problem is rarely one thing, and each route has something you or a clinician can act on.
  1. Physical health Breathing difficulties, pain, incontinence, not being able to get comfortable, seizures. Also eczema, reflux, tooth pain, ear infections.
  2. Anxiety and mood Fear of the dark or of being apart from you, and the effects of medicines: anti-epileptic drugs, stimulants and some antidepressants all affect sleep.
  3. A different internal body clock Sleep hormones may be released at different times. Children who are blind have a body clock that "cannot be guided by indicators from the light-dark cycle".
  4. Differences in sensory processing Bedtime can be distracting, confusing or distressing rather than calming.
  5. How settling back to sleep has been learned If a child has only ever fallen asleep with one thing happening, they need it again at 2am.

Pathway five is not about blame

Cerebra is explicit that this is "not a conscious process", and that it "may initially occur because children cannot (rather than will not) find any other way to settle themselves back to sleep". Your child is not manipulating you, and comforting them has not created a problem. Cerebra's conclusion across conditions is hopeful: changing some of the other risk factors "could lead to vast improvements".

NHS England adds that some children cannot tell you they have a sleep problem, so identification "may need to be based on observations or information from carers". What you have noticed is the evidence.

How common this is

The figures quoted vary wildly. The Sleep Charity says difficulties rise "to 80% with a SEND diagnosis", and NHS England says "up to eight in 10 children with additional needs are thought to have sleep problems". A figure of 86% also circulates, but the guide publishing it gives no source.

Pooled research using a validated questionnaire gives much lower numbers. Horwood and colleagues (2019, Sleep Health) combined 23 studies of 2,908 children with cerebral palsy: an abnormal total score on the Sleep Disturbance Scale for Children in 23.4% (95% confidence interval 18.8 to 28.4), and 26.9% for difficulty getting to sleep and staying asleep. Nadeem and colleagues (2025, Sleep Medicine, 42 studies) found 26% (17 to 37%).

Why the numbers disagree

They measure different things. The 80% figure counts any sleep issue a parent reports, across disabled children generally. The 23 to 26% figures count children scoring above a clinical cut-off on one validated scale, in one condition. Neither is wrong, and neither tells you about your child. Newman and colleagues (2006) found 23% of 173 children with cerebral palsy scored pathologically, "in comparison with 5% of children in the general population". However you measure it, sleep problems are several times more common.

Other figures, sources named: autism, 40 to 80% (The Sleep Charity; the National Autistic Society publishes none); Down's syndrome, around 50%. For learning disability Cerebra contrasts "fewer than 3 out of 10" children generally with "about 8 out of 10", but that rests on a 1992 study of children with severe learning difficulties, so treat it as an order of magnitude.

Rule out medical causes first

NICE, Cerebra, the Down's Syndrome Medical Interest Group, the Down's Syndrome Association and Scope all agree on this. Before any routine change or settling method, ask a clinician to look for a physical cause, because pain "may be causing or maintaining the sleep problems" (Cerebra). Worth naming at the appointment: pain, reflux, constipation, night-time seizures, ear infections, tooth pain, eczema, and every medicine including the timing of the last dose.

Snoring is a red flag, not a quirk

Cerebra warns that "regular and loud snoring could affect the quality of your child's sleep or be a sign of a health problem". NICE guidance on autism makes it an instruction to professionals: if a child "snores loudly, chokes or appears to stop breathing while sleeping, refer to a specialist" to check for obstructive sleep apnoea. Ask directly whether a referral is needed.

One caveat: children with a neurodisability "may present with atypical or subtle features", and "classical symptoms such as snoring or witnessed apnoeas are not always evident", showing instead as daytime irritability or fragmented sleep. No snoring does not rule it out.

Keep a two-week sleep diary

Two weeks is the consistent UK answer, from NICE, Cerebra, Scope and SIGN. Cerebra's columns: date, wake time, mood on waking, naps, when you started preparing for bed, when your child went to bed, when they got to sleep, night wakings, what you did, how long they took to resettle, total hours.

Sleep diary layout A grid of diary columns. Two areas are highlighted: the pair of columns recording time went to bed and time got to sleep, and the column recording what the parent did at each waking. DateWokeTo bed AsleepWoke inWhat I Back toTotal nightdidsleep in MonTueWedThu Gap between these two = a settling problem This column shows what may be keeping the pattern going
Separating "went to bed" from "got to sleep" shows a settling problem rather than a waking problem, and "what I did" records the response that may be maintaining the pattern. Scope suggests filling it in immediately, and asking school or respite carers to complete their part.

Where this comes from

Last checked 1 August 2026. This page is general information, not medical advice. If you are worried about your child, speak to your health visitor or GP.