Vivid nightmares could be early warning sign of lupus, Cambridge University warns

Horrific nightmares could be an early warning sign of the autoimmune disease lupus, scientists have found.

People reported vivid and disturbing dreams in the year before the onset of the disease. Visions included being attacked, trapped, crushed, falling or witnessing murders.

Many also suffered hallucinations or “daymares” in which they felt they were falling into an “Alice in Wonderland” like detached state. Often the “daymares” followed the nightmares.

Lupus is a chronic disease that causes inflammation in the joints and organs, including the brain and affects movement, brings skin rashes, and causes fatigue. It affects about 50,000 people in Britain and, in severe cases, it can be deadly.

To find out more about early symptoms, Cambridge University surveyed nearly 700 people living with the condition as well as 400 doctors.

They discovered that three in five lupus patients reported increasingly disrupted dreaming sleep – usually vivid and distressing nightmares – usually prior to hallucinating.

Prof David D’Cruz, senior study author from King’s 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.”

Researchers say doctors should ask patients about sleep disturbances and consider lupus as a possible explanation.

Misdiagnosis

In the past, patients have been misdiagnosed as having a psychotic episode when actually it was a symptom of an autoimmune disease.

During the study, 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.”

Prof Guy Leschziner, a study author and neurologist at Guy’s and St Thomas’ Hospital in London and author of The Secret World of Sleep, 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.”

Describing how the” daymares” or hallucinations feel, another patient from England said: “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.”

Lead author Dr Melanie Sloan from the Department of Public Health and Primary Care at 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 realise that these can be a part of autoimmune diseases.”

The research was published in the online journal eClinicalMedicine.