New research has found that experiencing an increase in disturbing dreams and daytime hallucinations could be an early sign of autoimmune diseases such as lupus.

A survey of people with the condition and those who treat them found that these neurological symptoms could also provide an ‘early warning system’ that an individual is approaching a flare-up of their condition.

The team behind the study say it is important medics recognise these symptoms of the condition, as their survey found that some people had been misdiagnosed or admitted to hospital with psychotic episode and/or suicidal ideation. It was only later discovered these symptoms were the first sign of their autoimmune disease.

Professor Guy Leschziner, a study author and neurologist at Guys’ and St Thomas’ hospital, said: “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.

“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.”

The international team, led by researchers at the University of Cambridge and King’s College London, carried out a survey of 676 people with lupus, an autoimmune inflammatory disease which can affect many organs including the brain, and 400 clinicians.

They also interviewed 69 people with systemic autoimmune rheumatic diseases, including lupus, and 50 clinicians.

Patients were asked about the timings of neurological and mental health symptoms, including depression and hallucinations – or ‘daymares’. They were also asked to list the symptoms in the order of when they happened as they experienced a flare in their condition.

Three in five patients experienced disrupted dream sleep and vivid nightmares, with a third saying this particular symptom started more than a year before the onset of lupus disease.

Just under one in four patients said they experienced ‘daymares’ but the majority said this symptom started after the onset of their disease.

The research team also found that for many, they experienced distressing nightmares just before the ‘daymares’, an experience which one patient described as “feeling like I’m Alice in Wonderland.”

Many said they were reluctant to discuss experiencing hallucinations with other people because of the stigma around it.

However, many of those interviewed said that using the term ‘daymares’ to describe their hallucinations was a positive step as it was a less frightening and stigmatised word.

Many of the clinicians who were interviewed said they had never considered that nightmares and ‘daymares’ could be linked to disease flares but agreed that recognising these early flare symptoms could help to improve care.

Lead author Dr Melanie Sloan from the University of Cambridge said: “It’s important that clinicians talk to their patients about these types of symptoms.

“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 realise that these can be a part of autoimmune diseases.”

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