A recent study has indicated that experiencing nightmares might be an early warning sign of a deadly disease.
The rise in frightening dreams at night, or “daymares” during waking hours, could signal the onset of autoimmune diseases such as lupus. Researchers involved in the study noted that one participant was so disoriented they felt as though they were in “Alice in Wonderland.”
The researchers aim for broader recognition that mental health and neurological symptoms should be considered early indicators of an imminent “flare,” or worsening, of the illness.
Published in the journal eClinicalMedicine, the study involved 676 lupus patients and 400 medical professionals. It was led by scientists from the University of Cambridge and King’s College London, who conducted detailed interviews with 69 people with systemic autoimmune rheumatic diseases, including lupus, and 50 clinicians.
Lupus is an autoimmune inflammatory disease known for affecting multiple organs, including the brain. Researchers inquired about the timing of 29 mental health and neurological symptoms such as loss of balance, hallucinations, and depression from the patients.
Participants were also asked to sequence these symptoms as they typically appear during their disease flare-ups.
One of the most frequently reported symptoms was disrupted dream sleep, noted by three out of five patients, with a third of these individuals experiencing this symptom over a year before their lupus diagnosis.
Just under one-quarter of patients reported hallucinations, and 85% of these individuals noted this symptom appeared at the onset of the disease or later.
Three out of five lupus patients and one in three of other rheumatology-related patients reported an increase in disrupted dreaming sleep filled with vivid nightmares just before experiencing hallucinations.
These nightmares were described as “vivid” and “distressing,” often involving themes of attacks or being trapped, crushed, or falling. An Irish patient described their nightmares as “Horrific, like murders, like skin coming off people, horrific.”
“I think it’s when I’m overwhelmed, which could be the lupus acting up…So I think the more stress my body is under, then the more vivid and bad the dreaming would be,” the patient added.
The study found that referring to hallucinations as ‘daymares’ led to a “lightbulb” moment for many participants as it seemed a less frightening and less stigmatized term.
A patient from England shared, “You said that word daymare and as soon as you said that it just made sense, it’s like not necessarily scary, it’s just like you’ve had a dream and yet you’re sitting awake in the garden.
“I see different things, it’s like I come out of it and it’s like when you wake up and you can’t remember your dream and you’re there but you’re not there.
“It’s like feeling really disorientated, the nearest thing I can think of is that I feel like I’m Alice in Wonderland.”
Many patients were hesitant to discuss their experiences with hallucinations, and many specialists admitted they had not previously considered nightmares and hallucinations as related to disease flares.
The majority expressed that they would, in the future, discuss nightmares and hallucinations with their patients, acknowledging that recognizing these early symptoms of a flare could provide an ‘early warning system’ to enhance care and potentially reduce clinic visits.
Lead author Dr. Melanie Sloan, from the University of Cambridge, emphasized, “It’s crucial that clinicians discuss these types of symptoms with their patients and take time to document each patient’s individual symptom progression.
“Patients often recognize which symptoms indicate their disease is flaring, but there’s a reluctance to discuss mental health and neurological symptoms, especially if they don’t realize these can be part of autoimmune diseases.”
Senior author Professor David D’Cruz, from King’s College London, noted, “For many years, I’ve discussed nightmares with my lupus patients, believing they were linked to disease activity.
“This research provides evidence of this link, and we are strongly encouraging more doctors to inquire about nightmares and other neuropsychiatric symptoms – which are often thought to be unusual but are actually quite common in systemic autoimmunity – to help us detect disease flares earlier.”
Some participants initially received misdiagnoses or were even hospitalized for psychotic episodes or suicidal feelings before being correctly diagnosed with their autoimmune disease.
A patient from Scotland explained, “At 18 I was diagnosed with borderline personality disorder, and then six months later with lupus at 19, so it’s all very close together and it was strange that when my [borderline personality disorder] was managed and my lupus was under control, it happened within six months.”
A nurse from Scotland observed, “I’ve seen them admitted for an episode of psychosis and lupus isn’t screened for until someone says ‘oh I wonder if it might be lupus?’
“But it was several months and very difficult… especially with young women, and it’s a learning curve to understand that this is how lupus affects some people and it’s not anti-psychotic drugs they needed, it’s like a lot of steroids.”
Study author Professor Guy Leschziner, a neurologist at Guys’ and St Thomas’ hospital, remarked, “We have long known that changes in dreaming may reflect alterations in physical, neurological, and mental health, and can sometimes signal the onset of disease.
“However, this is the first evidence that nightmares might also help us monitor a serious autoimmune condition like lupus, serving as an important alert to patients and clinicians alike that sleep symptoms may indicate an impending relapse.”
