For many people, nightmares are an unpleasant but occasional occurrence. However, new research suggests that for some individuals living with autoimmune disorders such as lupus, nightmares can be an early warning sign that their condition is getting worse.
A study led by University of Cambridge researcher Melanie Sloan found that around one-third of lupus patients reported experiencing vivid, disturbing nightmares or other sleep disturbances up to a year before other symptoms of a disease flare-up emerged. The findings add weight to anecdotal evidence and theories that the brain’s immune activity and dream life are inherently linked.
“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,” says neurologist and study author Guy Leschziner from Guy’s and St Thomas’ Hospitals in London.
“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.”
Lupus, also known as systemic lupus erythematosus (SLE), is an autoimmune disorder that causes the body’s immune system to attack its own tissues and organs, including the joints, skin, kidneys, blood cells, brain, heart and lungs. For reasons not fully understood, the disease goes through periods of flare-ups every few years marked by fever, fatigue, pain and other symptoms.
While not all lupus patients experience neurological or psychiatric symptoms during flares, around 40% do struggle with issues like nightmares, hallucinations, anxiety and cognitive impairment. However, these subjective experiences are often underreported by patients and overlooked by clinicians focused on more outwardly physical symptoms.
The new study, published in the journal Lupus Science & Medicine, suggests this mindset needs to change. Through an online survey of 676 lupus patients and interviews with 69 individuals with rheumatic diseases, the researchers found many reported extremely vivid, disturbing and frequent nightmares before other lupus flare symptoms manifested.
As one patient described it: “I think the more stress my body is under then the more vivid and bad the dreaming would be…I came to the conclusion that [the nightmares are] probably me fighting my own system.”
Another said the nightmares were so “horrific” they dreamt of “skin coming off people.” Some even reported experiencing a crossover of dreaming into waking life, describing “daymares” that left them disoriented and confused about what was real, comparing it to being “Alice in Wonderland.”
While the reasons for the connection between autoimmune brain involvement and dreaming are still unclear, the study authors point to emerging research in other neurological conditions. People with Parkinson’s disease, which has autoimmune links, often experience vivid dreams up to a decade before diagnosis. Nightmares have also been found to potentially predict the onset of dementia and multiple sclerosis flare-ups.
The study’s authors, including rheumatologist David D’Cruz, say they have directly observed this apparent dreaming-autoimmunity relationship with lupus patients. As D’Cruz stated: “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.”
Given these findings, the researchers advocate for clinicians to actively ask lupus and other autoimmune patients about any changes to their dreaming. This simple addition to medical assessments could provide an early warning system to detect impending flares and initiate treatment sooner.
While more research is still needed, this study hints that the human brain may possess a remarkable subconscious ability to sense when the body’s immune system has gone awry through vivid nighttime storytelling. By better understanding this connection, we may unlock new ways to listen to the messages our dreams are trying to tell us about our health.
The study was published in eClinicalMedicine.
