By Stephen Beech via SWNS
Nightmares could be early warning signs of potentially deadly diseases, according to a new study.
An increase in nightmares and hallucinations – or ‘daymares’ – may herald the onset of autoimmune diseases such as lupus, say scientists.
One patient in the study was so disorientated they felt like they were “Alice in Wonderland.”
Researchers want greater recognition that such mental health and neurological symptoms can act as an “early warning sign” that a patient is approaching a “flare” – where their illness worsens for a period.
The study, published in the journal eClinicalMedicine, involved 676 people living with lupus and 400 medics.
The international research team, led by University of Cambridge and King’s College London scientists, conducted detailed interviews with 69 people living with systemic autoimmune rheumatic diseases, including lupus, and 50 clinicians.
Lupus is an autoimmune inflammatory disease known for its effect on several organs, including the brain.
The researchers asked patients about the timing of 29 neurological and mental health symptoms including depression, hallucinations and loss of balance.
Patients were also asked if they could list the order that symptoms usually happened when their disease was flaring.
One of the most common symptoms reported was disrupted dream sleep, experienced by three out of five patients, a third of whom reported the symptom appearing over a year before the onset of lupus.
Just under one in four patients reported hallucinations, although for 85 percent of them the symptom did not appear until around the onset of disease or later.
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.
The nightmares were often “vivid” and “distressing” – involving 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.”
The interviewers found that using the term ‘daymares’ to talk about hallucinations often led to a “lightbulb” moment for the patients, and they felt that it was a less frightening and stigmatized word.
A patient from England said: “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.”
Patients experiencing hallucinations were reluctant to share their experiences, and many specialists said they had never considered nightmares and hallucinations as being related to disease flares.
The majority said they would in future talk to their patients about nightmares and hallucinations, agreeing that recognizing these early flare symptoms may provide an ‘early warning system’ enabling them to improve care and even reduce clinic times.
Lead author Dr. Melanie Sloan, of the University of Cambridge, said: “It’s important that clinicians talk to their patients about these types of symptoms and spend time writing down each patient’s individual progression of symptoms.
“Patients often know which symptoms are a bad sign that their disease is about to flare, but both patients and doctors can be reluctant to discuss mental health and neurological symptoms, particularly if they don’t realize that these can be a part of autoimmune diseases.”
Senior author Professor David D’Cruz, of Kings College London, said: “For many years, I have discussed nightmares with my lupus patients and thought that there was a link with their disease activity.
“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.”
Some patients in the study said they had initially been misdiagnosed or even hospitalized with a psychotic episode or feeling suicidal. It was only later found to be the first sign of their autoimmune disease.
One patient from Scotland said: “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] got under control and my lupus got under control was within six months.”
A nurse from Scotland said: “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 than that 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, said: “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.
“However, this is the first evidence that nightmares may also help us monitor such a serious autoimmune condition like lupus, and is an important prompt to patients and clinicians alike that sleep symptoms may tell us about impending relapse.”
