Sleep’s Early Warning Signs of Autoimmune Disease

Nightmares and hallucinations may be early signs of autoimmune diseases such as lupus, a new study suggests, potentially improving early diagnosis and treatment.

An increase in nightmares, hallucinations, or “white dreams” may indicate the beginnings of an autoimmune disease, such as lupus. This is the work of an international team led by researchers from the University of Cambridge and King’s College London.

They emphasize the importance of recognizing these mental health and neurological symptoms as early warning signs of an impending “flare-up” (a temporary worsening stage of the disease).

Research insights into lupus and mental health symptoms

In a study published in e-clinical medicine Today (May 20), researchers surveyed 676 lupus patients and 400 clinicians, and also surveyed 69 patients with systemic autoimmune rheumatic diseases (including lupus) and 50 clinicians. We conducted detailed interviews with people. Lupus is an autoimmune inflammatory disease known to affect many organs, including the brain.

In the study, the team also asked patients about the timing of 29 neurological and mental health symptoms, including depression, hallucinations, and loss of balance. In the interview, patients were also asked if they could list the order of symptoms that typically occur when the disease worsens.

patterns of nightmares and hallucinations

One of the more common symptoms reported is interrupted dream sleep, experienced by three out of five patients, with one-third of them saying this symptom appeared more than a year before the onset of their lupus disease. I reported it.

Just under one in four patients reported hallucinations, but in 85% of these, symptoms did not appear until around or after the onset of the illness. However, when researchers interviewed patients, they found that 3 in 5 lupus patients and 1 in 3 patients with other rheumatism-related conditions experience dreaming (usually vivid and painful) immediately preceding hallucinations. We found that patients reported increasing disturbances (nightmares). These nightmares were often graphic and harrowing, involving being attacked, trapped, crushed, and fallen.

Patient perspective and terminology

One patient from Ireland described her nightmares as follows: “It’s scary, like a murder, like when someone’s skin comes off, it’s scary… It’s like when I’m feeling overwhelmed, and my lupus may be getting worse… So the stress my body is under. I think it’s going to get even bigger.” Then the dream will become more vivid and bad. ”

Study interviewers found that using the word “daymare” when talking about hallucinations often resulted in a “lightbulb” moment for patients, making it a less scary and less stigmatizing word. I discovered what I felt.

A patient from the UK said:[When] You said the word daydream, and as soon as you say it makes sense, it’s like it’s not necessarily scary, it’s like you’re dreaming and you’re in the garden. It’s like I’m sitting awake…I see different things, it’s like when I get out of there it’s like when I wake up and I can’t remember the dream and I’m there But I’m not there…I feel really disoriented, and the closest thing I can think of is, I’m Alice in Wonderland. ”

Clinical significance and future directions

Patients experiencing hallucinations are reluctant to share their experiences, and many experts said they had never thought that nightmares or hallucinations were linked to a recurrence of the disease. Most patients said they would talk to patients about their nightmares and hallucinations in the future, and recognizing these flare-up symptoms early can improve treatment and save time by avoiding flare-ups earlier. It was agreed that an “early warning system” could be provided that could shorten the time.

Lead author Dr Melanie Sloan, from the University of Cambridge’s School of Public Health and Primary Care, said: Patients often know which symptoms are bad signs that their disease is about to get worse, but they are especially aware that these may be part of an autoimmune disease. If not, both patients and doctors may be reluctant to discuss mental health or neurological symptoms. ”

Evidence linking neuropsychiatric symptoms and disease activity

Professor David D’Cruz from King’s College London, senior author of the study, said: This study provides evidence that more doctors are trying to detect disease flare-ups early on, and to help detect disease flare-ups that are considered abnormal but are actually very common in systemic autoimmunity. We strongly encourage you to ask about nightmares and other neuropsychiatric symptoms. ”

The importance of recognizing these symptoms is such that some patients are initially misdiagnosed or even hospitalized with a psychotic episode or suicidal ideation, only to later discover that it is the first sign of an autoimmune disease. This was highlighted by reports that it has been found that

One patient from Scotland said: “I was diagnosed with borderline personality disorder at 18 and then six months later with lupus at 19, so it was all very close together and it was strange when my symptoms worsened.” [borderline personality disorder] My systemic lupus erythematosus was also controlled within 6 months. ”

A nurse from Scotland said: “I’ve seen patients come in with psychotic episodes, but they don’t test for lupus until someone says, ‘Oh, it might be lupus’…but that was months and it was very difficult…especially In the case of young women, we’re finding out more and more that that’s how lupus affects some people, and what they need isn’t an antipsychotic, but something like a high dose of steroids. .”

The bottom line on sleep and autoimmune diseases

Study author Professor Guy Leszziner, neurologist at Guy and St Thomas’ Hospital and author of The Secret World of Sleep, said: It can also be an early sign of illness. However, this is the first evidence that nightmares may be useful in monitoring serious autoimmune diseases like lupus, making it important for patients and clinicians alike that sleep symptoms may be helpful in warning of an impending flare-up. This is an important hint that you may be able to tell us. ”

Reference: “Timing of neuropsychiatric prodrome and symptoms associated with disease onset and/or flare in SLE: Results from the mixed-methods international INSPIRE study” May 20, 2024 EC clinical medicine.
DOI: 10.1016/j.eclinm.2024.102634

This research was funded by The Lupus Trust and is part of the INSPIRE project (Iinvestigating Neuro psychiatry Ssymptoms Prelevance and Iinfluence RHematology patients Eexperience).