Having nightmares can not only be terrifying and disrupt our rest, but could also predict the onset of autoimmune diseases such as lupus, as discovered by an international team led by researchers from the University of Cambridge and King’s College London. According to the results of the study they carried out, experiencing an increase in nightmares and hallucinations – or ‘daytime nightmares’ – may be an indication that you are going to suffer from one of these pathologies.
The researchers argue that there needs to be greater recognition that these types of mental health and neurological symptoms can act as an early warning sign that a person is about to suffer a ‘flare’ in which their illness worsens over a period of time. The findings have been published in eClinicalMedicine.
To carry out the study, its authors surveyed 676 people with lupus – an autoimmune inflammatory disease that affects many organs, including the brain – and 400 doctors, in addition to conducting detailed interviews with 69 people with systemic autoimmune rheumatic diseases (including lupus). and 50 doctors.
In the study, the team also asked patients about the timing of 29 neurological and mental health symptoms (such as depression, hallucinations, and loss of balance). In the interviews, patients were also asked to list the order in which symptoms generally appeared when their illness was in flare.
Nightmares and hallucinations: an ‘early warning system’ of an outbreak
One of the most common symptoms reported was dream-interrupted sleep, experienced by three out of five patients, of whom a third indicated that this symptom appeared more than a year before the onset of lupus disease. Just under one in four patients reported hallucinations, although for 85% of these, the symptom did not appear until around the onset of the illness or later.
However, when the researchers interviewed the patients, they found that three in five patients with lupus and one in three with other rheumatic pathologies reported that their dreams were increasingly disturbing – usually vivid and distressing nightmares, including being attacked, trapped, , crushed or fallen – just before his hallucinations.
One patient from Ireland described his nightmares as: “Horrible, like murder, like skin coming off people, horrible… I think it’s like when I’m overwhelmed, which could be lupus getting worse… So I think the more stress my body, the more vivid and bad the dreams are.” The study’s interviewers found that using the term ‘daylight nightmare’ to refer to hallucinations often elicited a ‘moment of revelation’ for patients, and they felt it was a less frightening and stigmatizing word.
Patients experiencing hallucinations were reluctant to share their experiences, and many specialists said they had never considered nightmares and hallucinations to be related to disease flares. Most said they would talk to their patients about nightmares and hallucinations in the future, agreeing that recognizing these early symptoms of flares could provide an ‘early warning system’ allowing them to improve care and even reduce consultation times. Avoid outbreaks at an earlier stage.
“This is the first evidence that nightmares can also help us control an autoimmune disease as serious as lupus and a warning that sleep symptoms can inform us of an imminent relapse.”
“It is important for doctors to talk to their patients about these types of symptoms and spend time noting each patient’s individual progression of symptoms. Patients often know which symptoms are a bad sign that their illness is about to flare up, but both patients and doctors may be reluctant to discuss mental health and neurological symptoms, particularly if they do not realize that these “They may be part of autoimmune diseases,” said lead author Dr. Melanie Sloan, from the Department of Public Health and Primary Care at the University of Cambridge.
Lead author of the study, Professor David D’Cruz from King’s College London, said: “For many years, I have discussed nightmares with my lupus patients and thought there was a connection with their disease activity. “This research provides evidence for this, and we are encouraging more doctors to ask about nightmares and other neuropsychiatric symptoms – considered unusual, but actually very common in systemic autoimmunity – to help us detect disease flares earlier.”
The importance of recognizing these symptoms was highlighted by reports that some patients had initially been misdiagnosed, or even hospitalized with a psychotic episode or suicidal ideation, which was later found to be the first sign of their autoimmune disease.
“We have long been aware that disturbances in dreams can mean changes in physical, neurological and mental health and can sometimes be early indicators of illness. However, this is the first evidence that nightmares can also help us manage an autoimmune disease as serious as lupus, and it is an important warning to both patients and doctors that dream symptoms can tell us about a relapse. imminent,” concludes Professor Guy Leschziner, author of the study and neurologist at Guys’ and St Thomas’ hospital.
In statements to SMC Spain María Guadalupe Zavala Cerna, Research Director at the Health Sciences Academic Unit of the Autonomous University of Guadalajara (Mexico), highlighted that this study “provides the opportunity to explore, using a mixed methodology, the possible identification of prodromes (manifestations related to symptoms that occur before the appearance of clinical findings typically related to the onset or complication of a disease). In the case of autoimmune diseases, this is desirable, due to the difficulty and time patients must wait before receiving a diagnosis. This is the case of systemic lupus erythematosus (SLE), but especially the neuropsychiatric involvement of SLE.”
“This analysis highlights the presence of some symptoms a year before the onset of their illness, including severe headache (41%), low mood (34%), sleep interruptions or nightmares (32%), anxiety (39%), seizures (36%) and obsessive thoughts or compulsive behaviors (36%), which, according to the authors, suggests that these prodromes could be early manifestations of neuropsychiatric involvement in SLE and other autoimmune diseases with systemic involvement. However, in order to clarify the predictive role that these manifestations may have in the onset of the disease or a reactivation episode, it is necessary to carry out studies with quantitative methodology where these frequencies can be extrapolated to an inferential analysis and there is a lower amount of biases,” he adds.
