May 30, 2024

Nightmares and Hallucinations as Early Indicators of Autoimmune Diseases like Lupus

Researchers from the University of Cambridge and King's College London have uncovered that an increase in nightmares and hallucinations, sometimes called ‘daymares,' may signal the early stages of autoimmune diseases such as lupus. This new study, published in eClinicalMedicine, involved surveys and interviews with hundreds of patients and clinicians, revealing that these symptoms often precede disease flare-ups. Recognizing these early warning signs could improve patient care by enabling timely intervention and preventing severe flare-ups.

### Study Overview and Key Findings

The research team surveyed 676 individuals with lupus and 400 clinicians who care for people with this condition. Additionally, they conducted in-depth interviews with 69 individuals living with systemic autoimmune rheumatic diseases, including lupus, and 50 clinicians. Lupus is an autoimmune inflammatory disease that affects multiple organs, including the brain.

One of the most common symptoms reported was disrupted sleep, particularly vivid and distressing nightmares. Three out of five individuals experienced this symptom, with a third noting it appeared more than a year before the onset of lupus. Just under one in four people reported hallucinations, but 85% of them experienced these symptoms around the onset of the disease or later. The interviews revealed that three in five lupus patients and one in three individuals with other rheumatology-related conditions experienced increasingly disrupted dream sleep just before their hallucinations began.


Lead author Dr. Melanie Sloan from the University of Cambridge emphasized the importance of these findings. She explained that neuropsychiatric symptoms like nightmares could serve as an early warning system for impending autoimmune disease flare-ups. Sloan highlighted that these symptoms are not typically included in diagnostic criteria or considered by many doctors, yet they are common among patients with lupus and other systemic rheumatic diseases.

The study also found that referring to hallucinations as "daymares" helped patients understand and discuss their experiences more comfortably. This term was less stigmatizing and frightening, making patients more willing to share their symptoms with clinicians. The researchers stressed the need for better communication between patients and doctors to recognize and act upon these early warning signs.

Dr. Guy Leschziner, a neurologist and study author, noted that the exact mechanisms by which lupus flare-ups might precipitate nightmares are currently unknown. However, he speculated that inflammation or infection anywhere in the body can cause nightmares, similar to "fever dreams." This might be due to the effects of inflammation mediators, such as cytokines, on the brain, resulting in less stable REM sleep. Another possibility is direct inflammation of the brain disrupting sleep and dreaming circuits.

James Giordano, a professor of neurology and biochemistry at Georgetown University Medical Center, praised the study for examining the link between psychiatric symptoms and lupus. He noted that identifying these symptoms early could aid in the diagnosis and management of systemic lupus erythematosus (SLE), particularly the neuropsychiatric variant (NPSLE).

Giordano cautioned that not all psychiatric symptoms should be considered indicative of NPSLE, especially in individuals with a history of psychiatric issues. However, for those with other rheumatological signs, these symptoms could be valuable in diagnosing and predicting disease flare-ups. He emphasized the need for greater medical and societal understanding to help patients confidently report these symptoms, recognizing them as part of their disease.


Dr. Sloan added that similar symptoms could also indicate other autoimmune conditions. Although the study focused on lupus, interviews with individuals suffering from other autoimmune rheumatic diseases, such as Sjogren's syndrome, vasculitis, and systemic sclerosis, revealed similar neuropsychiatric symptoms during flare-ups. This under-researched area requires more attention to improve patient outcomes and reduce the stigma associated with reporting psychiatric symptoms.

In conclusion, the study highlights the critical role of recognizing neuropsychiatric symptoms as early indicators of autoimmune diseases like lupus. Improved awareness and communication between patients and clinicians can lead to earlier detection and treatment, potentially preventing severe disease flare-ups and improving patient care.