Black Girl Screaming Covering Ears Sitting In Bed At Home

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LONDON — It happens to even the calmest of us from time to time: you wake up from a terrifying dream, your heart is racing, and your mind reeling from the disturbing images that seemed all too real. For most people, nightmares are an occasional and unsettling inconvenience. But what if these intense, frightening dreams were actually a warning sign of something more serious lurking beneath the surface? A new study published in eClinicalMedicine suggests that nightmares may be an early indicator of an autoimmune disease flare-up.

The study, led by researchers from the University of Cambridge and King’s College London, focused on systemic lupus erythematosus (SLE), a complex autoimmune disease that can affect multiple organ systems. When lupus directly impacts the brain and nervous system, it is known as neuropsychiatric SLE (NPSLE). The researchers surveyed 676 lupus patients and 400 clinicians and conducted in-depth interviews with 69 patients with various systemic autoimmune rheumatic diseases (SARDs) and 50 clinicians.

One of the most intriguing findings of the study was the link between increasingly disrupted dreaming sleep, or nightmares, and the onset of hallucinations in some lupus patients. Overall, a quarter of patients experienced hallucinations, with 85% reporting these didn’t occur until the onset of the disease or later. However, a staggering 61% of lupus patients who experienced hallucinations reported having increasingly disturbed dreams before the onset of the hallucinations. This connection was less pronounced in other SARDs (34%), suggesting that nightmares might be a more specific warning sign for lupus.

“For many years, I have discussed nightmares with my lupus patients and thought that there was a link with their disease activity,” says senior study author Professor David D’Cruz, from Kings College London, in a media release. “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.”

Autoimmune diseases
Autoimmune diseases. (Image by Pikovit on Shutterstock)

Brain inflammation could be to blame

But what do nightmares have to do with autoimmune diseases? The answer may lie in the complex interplay between the immune system and the brain. Autoimmune diseases occur when the body’s immune system mistakenly attacks healthy cells and tissues. In the case of lupus, this can lead to inflammation and damage in various organs, including the brain. The study’s authors hypothesize that the increase in nightmares may be a result of early, subtle changes in the brain caused by the autoimmune process.

The types of nightmares reported by lupus patients in the study were often disturbing and intense. Some described dreams of being crushed, trapped, or attacked, while others reported violent or frightening scenarios involving themselves or their loved ones. One participant even likened their nightmares to being “Alice in Wonderland,” with a sense of disorientation and a blurring of the lines between dreams and reality.

Another was particularly graphic: “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.”

Interestingly, the study also introduced the concept of “daymares” as a way to discuss hallucinations with patients. Daymares, as the name suggests, are vivid, dream-like experiences that occur during waking hours. When researchers used this term during interviews, many patients had a “lightbulb” moment, recognizing that they had experienced similar phenomena but had not previously identified them as hallucinations.

One participant described their daymares as “like I’m asleep and dreaming but then I’m not actually asleep but what I see is kind of like a dream where things are changing quickly.” Another likened the experience to being “in-between asleep and awake.” By using the more relatable and less stigmatized term “daymare,” researchers were able to encourage patients to share these often-frightening experiences more openly, providing valuable insights into the neuropsychiatric manifestations of their disease.

Nightmares should be taken seriously by doctors

While nightmares alone may not be enough to diagnose an autoimmune disease, they could serve as an important early warning sign, prompting patients and their healthcare providers to be more vigilant for other symptoms of a flare-up. By recognizing these prodromal symptoms, which may also include changes in mood, cognitive function, or sensory perception, patients and clinicians can work together to initiate timely treatment and potentially prevent the flare from escalating.

However, it is important to note that the study’s findings are largely exploratory and require further validation from future studies. Additionally, the study relied on patient-reported data, which may be subject to recall bias and other limitations. More research is needed to fully understand the relationship between nightmares and autoimmune diseases, as well as to develop effective strategies for using this information to improve patient care.

Despite these limitations, the INSPIRE study offers a tantalizing glimpse into the potential role of nightmares as a harbinger of autoimmune disease activity. For those living with lupus or other SARDs, paying attention to the content and frequency of their dreams may provide valuable insights into their health and help them work with their healthcare team to manage their condition more effectively.

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