A recent study conducted by researchers from the University of Cambridge and King’s College London has found that an increase in nightmares and hallucinations, also known as ‘daymares,’ may indicate the early stages of autoimmune diseases like lupus. The study surveyed and interviewed hundreds of patients and clinicians, revealing that these symptoms often precede disease flares. Recognizing these early warning signs could lead to improved patient care and prevent severe flare-ups by allowing for timely intervention.
The study, published in eClinicalMedicine, involved surveying 676 individuals with lupus and 400 clinicians who provided care for people with this condition. In addition, in-depth interviews were conducted with 69 individuals living with systemic autoimmune rheumatic diseases, including lupus, and 50 clinicians. Lupus is an autoimmune inflammatory disease that affects multiple organs, including the brain. Patients were asked about the timing of 29 neurological and mental health symptoms, such as depression, hallucinations, and loss of balance. The study found that disrupted dream sleep was a common symptom experienced by three out of five individuals, with a third noting that this symptom appeared more than a year before the onset of lupus.
One of the key findings of the study was that neuropsychiatric symptoms, such as nightmares, could serve as an early warning system for autoimmune disease flare-ups. The study revealed that nightmares often involved scenarios of being attacked, trapped, crushed, or falling. Participants described their nightmares as horrific and graphic, involving scenes such as murders and people’s skin coming off. Referring to hallucinations as “daymares” often triggered a moment of recognition for patients, as they found this term to be less frightening and stigmatizing. The study also found that patients experiencing hallucinations were hesitant to discuss them with doctors, and many specialists had not previously considered a link between nightmares, hallucinations, and disease flare-ups.
Melanie Sloan, PhD, lead author of the study, emphasized that patients and doctors need to work together to identify a pattern of symptoms that occur before flare-ups in order to take action and seek earlier treatment. Sloan highlighted the importance of discussing mental health and neurological symptoms with doctors, as these symptoms can often be hidden or misattributed. While the mechanisms behind nightmares precipitated by lupus flare-ups are currently unknown, inflammation or infection in the body may play a role in disrupting brain circuits that regulate sleep and dreaming. Early detection of flare-ups is crucial, as lupus can cause organ damage, including to the brain, and may even lead to death in some cases.
James Giordano, PhD, a professor of neurology and biochemistry from Georgetown University Medical Center, noted that the presence of psychiatric signs and symptoms before formal diagnosis or flare-ups of lupus is an important marker for aiding in diagnosis and assessing prognosis. These findings may help mitigate individuals’ hesitance to report psychiatric symptoms out of fear of stigmatization. While the study focused on lupus, Sloan emphasized that these symptoms could also be indicative of other autoimmune conditions, such as Sjogrens, vasculitis, and systemic sclerosis. Increased medical and societal understanding of these symptoms could help patients feel more confident in reporting them to their healthcare providers.
