By Alan Lyndon
Researchers have found that nightmares, particularly intense and detailed nightmares, can be an early warning sign of the onset or flareup of lupus.
A study published in eClinicalMedicine investigated the timings of autoimmune disease onset and subsequent flares, particularly in patients diagnosed with SLE (systemic lupus erythematosus) and other autoimmune rheumatic diseases, and found a correlation to a series of nightmares, referred to as neuropsychiatric symptoms.
SLE patients were asked to report when they had first experienced each of 29 neuropsychiatric symptoms (such as depression, loss of balance, disrupted sleep, fatigue). Three out of five lupus patients, and one in three with other rheumatology-related diseases, reported increasingly disrupted dreaming sleep. These nightmares were often vivid and distressing, involving being attacked, trapped, crushed or falling, according to the study led by Melanie Sloan, a researcher in the department of public health and primary care at the University of Cambridge in the United Kingdom.
One patient reported 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.”
Patients often described recurring frightening dreams where they or their families are the victim: “They are usually quite frightening, like there’s a serial killer after me and the last few years I have the same one … if [it] was like the serial killer one and he’s got my legs or something I can still feel something on my legs even when I’m then awake.”
During interviews, patients often differentiated among different types, timings, and potential causes of the same symptoms. For example, several patients described how they felt that some types of depressive symptoms were directly attributable to active inflammation due to its time of onset, and differences in type and intensity compared to their more “reactive” low mood that could be more attributable to a consequence of psychological distress. Many patients also described a type of sudden severe “hit like a truck” fatigue coinciding with flare activity which they could differentiate from physical deconditioning or the more chronic fatigue that many experienced indefinitely.
Most rheumatologists acknowledged that they did not have a medical explanation for this received wisdom, and the vast majority talked about timing of diagnosis as opposed to timing of symptom onset: “It is a mystery, we’ve no particular reasoning as to why we all say psychosis and hallucinations would occur near the diagnosis of lupus. I’m sure there’s a good reason because it’s well established but I don’t know the reason.”
Sleep disorder specialist Dr. Carlos Schenck, a professor and senior staff psychiatrist at the University of Minnesota in Minneapolis, warned that not all nightmares are indicative of a lupus diagnosis. “This study could alarm the general public into believing or worrying about whether they have lupus or a related autoimmune disorder if they have nightmares or hallucinations, which are what doctors call ‘nonspecific symptoms,’ meaning that a variety of conditions (medical and psychiatric) can manifest with these symptoms,” Schenck told CNN regarding this study.
