Nightmares and Hallucinations: Early Warnings of Autoimmune Diseases

Nightmares and hallucinations, or ‘daymares’, may signal the onset of autoimmune diseases like lupus, according to an international team led by the University of Cambridge and King’s College London.

The team emphasizes the need for greater acknowledgment of mental health and neurological symptoms as potential early warnings of disease worsening. They surveyed 676 lupus patients, 400 clinicians, and conducted detailed interviews with 69 individuals with systemic autoimmune rheumatic diseases and 50 clinicians.

Three in five patients reported disrupted dream sleep, with a third experiencing this symptom over a year before lupus onset. Nearly one in four patients had hallucinations, although 85% reported this symptom around disease onset or later.

Interviews revealed that three in five lupus patients and one in three with other rheumatology-related conditions experienced increasingly disrupted dreaming sleep, usually vivid and distressing nightmares, just before hallucinations.

Patients often found the term ‘daymares’ less frightening and stigmatizing when discussing hallucinations. Many were reluctant to share their experiences, and some specialists had never considered a link between nightmares, hallucinations, and disease flares.

“Clinicians should discuss these symptoms with their patients and document each patient’s individual progression of symptoms,” said Dr. Melanie Sloan, lead author. Patients often know which symptoms signal a disease flare, but both patients and doctors may be reluctant to discuss mental health and neurological symptoms.

Professor David D’Cruz, senior study author, encourages more doctors to ask about nightmares and other neuropsychiatric symptoms to detect disease flares earlier.

Some patients were initially misdiagnosed or hospitalized due to these symptoms, which were later found to be the first sign of their autoimmune disease.

Professor Guy Leschziner, a study author and neurologist, said, “We’ve long known that changes in dreaming may signify changes in physical, neurological, and mental health, and can sometimes be early indicators of disease. This is the first evidence that nightmares may also help us monitor serious autoimmune conditions like lupus.”

The research, funded by The Lupus Trust, is part of the INSPIRE project.

Source:

University of Cambridge

Journal reference:

Sloan, M., et al. (2024) Neuropsychiatric prodromes and symptom timings in relation to disease onset and/or flares in SLE: results from the mixed methods international INSPIRE study. eClinicalMedicine. doi.org/10.1016/j.eclinm.2024.102634.