Potential early warning sign for autoimmune disease revealed

Nightmares and hallucinations — or “daymares” — may be early warning signs for the onset of an autoimmune disease or a flare-up, new research shows.

“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,” senior study author David D’Cruz, of King’s College London, said in a statement.

Twenty-four million to 50 million Americans have an autoimmune disease, which is when the body’s immune system mistakenly attacks its own healthy tissue. There are more than 80 types of autoimmune diseases, including rheumatoid arthritis, Crohn’s disease and psoriasis.

This study — published this week in eClinicalMedicine — focuses on lupus, a condition that can cause inflammation throughout the body. Researchers surveyed 676 people with lupus about the timing of 29 neurological and mental health symptoms such as depression, hallucinations and loss of balance.

The study authors interviewed additional lupus patients to find out how their symptoms emerged when their disease flared up.

Three in five patients reported experiencing disrupted dream sleep — a third of them said this symptom appeared over a year before the onset of lupus.

Nearly 1 in 4 participants revealed hallucinations, though for most of these people, the hallucinations did not occur until around the onset of the disease or later.

Hallucinations were often preceded by “vivid and distressing” nightmares — people were being attacked, trapped, crushed or falling. One person described their nightmares as “horrific, like murders, like skin coming off people.”

People were more reluctant to talk about their hallucinations until the researchers started referring to them as “daymares.”

“[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,” one patient told the study authors.

“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,” they continued. “It’s like feeling really disorientated, the nearest thing I can think of is that I feel like I’m Alice in Wonderland.”

The study authors stressed the importance of clinicians recognizing these symptoms early to prevent misdiagnosis. There’s no cure for lupus, but symptoms and inflammation can be managed with medications and lifestyle changes.

“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,” said lead author Dr. Melanie Sloan, of the Department of Public Health and Primary Care at the University of Cambridge.

“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,” she added.