Nightmares and hallucinations may be early warning signs of serious disease

Researchers have uncovered a surprising connection between nightmares, hallucinations, and the onset of autoimmune diseases, such as lupus. The findings suggest that these mental health and neurological symptoms could serve as early warning signs of disease flares.

This revelation comes from a comprehensive study conducted by researchers from the University of Cambridge and King’s College London, published in eClinicalMedicine.

Connection between nightmares and disease

The research team surveyed 676 people living with lupus and 400 clinicians, as well as conducting in-depth interviews with 69 individuals with systemic autoimmune rheumatic diseases (including lupus) and 50 clinicians.

The study aimed to explore the timing and prevalence of 29 neurological and mental health symptoms, such as depression, hallucinations, and loss of balance, in relation to disease flares.

Professor David D’Cruz from Kings College London, a senior author of the study, shared his experience.

“For many years, I have discussed nightmares with my lupus patients and thought that there was a link with their disease activity,” D’Cruz recounted.

“This research provides evidence of this, and we are strongly encouraging more doctors to ask about nightmares and other neuropsychiatric symptoms — thought to be unusual, but actually very common in systemic autoimmunity — to help us detect disease flares earlier,” D’Cruz concluded.

Prevalence of disrupted dreams and hallucinations

The study revealed that three in five patients experienced disrupted dream sleep, with a third reporting this symptom appearing over a year before the onset of lupus disease.

Hallucinations were reported by just under one in four patients, with 85% experiencing this symptom around the onset of the disease or later.

Interestingly, when interviewed, three in five lupus patients and one in three with other rheumatology-related conditions reported increasingly disrupted dreaming sleep – usually vivid and distressing nightmares – just before their hallucinations. These nightmares often involved being attacked, trapped, crushed, or falling.

One patient from Ireland described their nightmares as: “Horrific, like murders, like skin coming off people, horrific…I think it’s like when I’m overwhelmed which could be the lupus being bad…So I think the more stress my body is under then the more vivid and bad the dreaming would be.”

Power of “daymares”

The study interviewers found that using the term “daymares” to discuss hallucinations often led to a “lightbulb” moment for patients, as it felt less frightening and stigmatized.

A patient from England shared their experience: “[When] 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.”

Recognizing nightmares as disease symptoms

Lead author Dr. Melanie Sloan from the Department of Public Health and Primary Care at the University of Cambridge emphasized the importance of clinicians discussing these symptoms with their patients and documenting each individual’s progression of symptoms.

Recognizing nightmares and hallucinations as early flare symptoms may provide an “early warning system,” enabling improved care and potentially reducing clinic times by averting flares at an earlier stage.

Professor Guy Leschziner is a study author, neurologist at Guys’ and St Thomas’ hospital, and author of The Secret World of Sleep. He added, “We have long been aware that alterations in dreaming may signify changes in physical, neurological and mental health, and can sometimes be early indicators of disease.”

Leschziner went on to say that this is the first evidence that nightmares may also help monitor such a serious autoimmune condition like lupus. The science indicates this is an important prompt to patients and clinicians alike that sleep symptoms may tell us about impending relapse.

Misdiagnosis and increased awareness

The study also highlighted the importance of recognizing these symptoms to avoid misdiagnosis. Some patients reported initially being misdiagnosed or even hospitalized with a psychotic episode and/or suicidal ideation, which was only later found to be the first sign of their autoimmune disease.

A nurse from Scotland shared her experience: “I’ve seen them admitted for an episode of psychosis and the 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 learning more that that is how lupus affects some people and it’s not anti-psychotic drugs they needed, it’s like a lot of steroids.”

Managing disease by monitoring nightmares

The fascinating research led by Dr. Melanie Sloan and Professor David D’Cruz uncovers the surprising connection between nightmares, hallucinations, and autoimmune disease flares.

By recognizing these mental health and neurological symptoms as potential early warning signs, clinicians and patients can work together to improve disease management and enhance the quality of life for those living with autoimmune conditions.

This study emphasizes the importance of open communication between patients and healthcare providers, as well as the need for increased awareness within the medical community.

As we continue to explore this fascinating link, we move closer to a future where autoimmune diseases are detected earlier, managed more effectively, and their impact on individuals’ lives is minimized.

The full study was published in the journal EClinicalMedicine.

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