Sleep walking

Hi my mum who is in her 70s is receiving injections for low B12 levels. Recently she has been sleep walking. Is this something associated with low B12? There are no other underlying diagnosed conditions. Thank you!

[Foggyme Administrator]

Hi Shingleway. B12 deficiency can indeed cause sleep disorders a) because B12 is involved with the production of melatonin (the sleep hormone) and b) because B12 deficiency causes symptoms that impact on sleep patterns (fatigue, restlessness, insomnia etc), and thus can lead to sleepwalking (though not everyone with B12 deficiency gets this).

Other vitamin and mineral deficiencies can also produce symptoms they may lead to sleepwalking (i.e. iron, vitamin D, magnesium etc.), so might be worth investigating this as possible underlying cause.

It's also worth noting that there can be many other causes of sleepwalk so if this gets worse or you are worried about it, probably a good idea to discuss with your mum's doctor.

Hope you manage to find some answers soon....not to mention respite for your mum.

Take care both 👍

[Hidden]

Hi Foggyme do you know of any clinical papers or articles I can give to mum to give to her GP? It’s the 4th time she has done it and hurt herself badly and I need them to take it seriously. Thank you so much for replying x

[Foggyme Administrator in reply to Hidden]

Hi Shingleway. Hmm...a tough question because it depends on the underlying cause of the sleepwalking and finding a solution depends of her GP's willingness to investigate and come up with a solution.

Things I'd think about first:

1. Is she getting adequate treatment for her B12 deficiency? If symptoms return before her next injection, are relieved by that injection, then return before the next injection is due, then it's likely that her B12 deficiency is being under-treated. In addition, if neurological symptoms are present, then B12 treatment should be much more intensive (following loading doses, every other day until no further improvement - perhaps for many months - and then an injection every eight weeks (many GP's don't know about this regime). (See BNF for prescribing regime for those with neurolgical symptoms - third paragraph down - GP's don't usually read that far. Also - The BNF describes this as treatment for PA. However, that is a moot point because the treatment for PA is treatment of the B12 deficiency it causes. So the treatment for B12 deficiency (from whatever cause) is the same as the treatment for PA).

Here's some links to information about the above:

bnf.nice.org.uk/drug/hydrox...

(BNF B12 Deficiency: Hydroxocobalamin Treatment Regimes)

stichtingb12tekort.nl/weten... (B12 Treatment Safety / Long Term Treatment for neurological symptoms)

Suggestion - ask GP to increase frequency of B12 injections. If her sleepwalking is a consequence of symptoms of B12 deficiency, then this may help.

GPs often mistakenly think that no more B12 is required because the serum B12 level is within 'normal' limits. This is nonsense. Serum B12 levels are usually very high following injections and are no indicator as to the efficacy of treatment. This should be assessed on the symptoms experienced by the patient and not according to serum B12 levels...and if symptoms are still present, this is indicative that more frequent B12 injections are needed (assuming that there is no underlying cause).

Here's some information about serum B12 levels in general / following treatment (in case her GP mistakenly uses this as a reason not to prescribe more frequent B12 injections).

stichtingb12tekort.nl/weten... (Problems with Serum B12 Test)

stichtingb12tekort.nl/weten... (Testing B12 During Treatment)

Also - read the second and third PAS pinned posts to the right of this page - much more information there about B12 deficiency which may help with getting appropriate treatment from a GP.

Also - as suggested above - ask GP to test vitamin D, ferritin, magnesium and folate - may be underlying deficiency involved.

Have to say that any GP that understands B12 deficiency would have no trouble prescribing additional injections - but sadly this is rare. If you think under-treatment with B12 may be the problem, then self-injection is an option (we can advise on this if it's a route you and your mum decide to take).

In terms of research papers specifically about sleepwalking and B12 deficiency, I've had a search and can't track anything down.

Here's the guidelines for the investigation of sleep disorders in the elderly, in general - but don't think that there's much here that your GP will either be interested in, or read. But it might be useful for you if additional B12 and ensuring appropriate levels of other vitamins don't do the trick, and you want to investigate further.

ncbi.nlm.nih.gov/pmc/articl...

I'm also wondering if your mum has anyone who can read the B12 information and go along to the surgery with her to try and get the GP to take this seriously - and take action (more B12 and investigate other potential causes). GP's - sadly - are often more attentive and proactive if another person's in the room to support the patient. Just might need someone to speak up for her and give the GP an extra nudge in the right direction.

Unfortunately, many GP's do not take these sorts of issues seriously and simply assume that it's the product of aging...and whilst it can be (but nevertheless should be investigated) it would be a shame if the often overlooked remedy of giving more B12 injections is ignored. Potentially to your mum's detriment.

Good luck 👍

[Hidden in reply to Foggyme]

You are amazing and thank you for spending so much time on this response. It is a great help. I will get reading!

[Foggyme Administrator in reply to Hidden]

No problem. Just do a new post if you need more help.

Good luck to you both 👍

[Hidden in reply to Foggyme]

It’s a great help and thank you again.