Nightmares are unpleasant, but perfectly normal – for many. However, my colleagues and I actually have recently discovered that they may also treat autoimmune diseases, resembling lupus.
Our study, published in The Lancet. eClinicalMedicine Journal, explored possible early warning signs of an autoimmune disease flare-up. We surveyed 676 patients with lupus and 400 physicians and conducted greater than 100 in-depth interviews.
We asked concerning the neurological and mental health symptoms that patients experience, and once they occurred in relation to when their illness first began. This included symptoms resembling low mood, hallucinations, tremors and fatigue. We also asked if there was a typical pattern of symptoms for patients because that they had flare-ups (disruptive symptoms).
Many patients can describe symptoms that occurred just before their flare-up. Although the patterns varied between different people, they were often similar in all and sundry's flare-up. Patients often knew which symptoms were signs that their disease was about to worsen.
Nightmares have been found to precede autoimmune diseases in other neurological diseases. Descriptions of flare-related nightmares in our study often included being attacked, trapped, crushed, or falling. Many people were very nervous. One person described them as: “Horrible, like murder, like people's skin coming off, horrible.”
Another essential finding was that these nightmares often preceded illness flare-ups, particularly in those that were experiencing hallucinations as a pattern of their illness on the time. This was more likely in individuals with lupus than in other rheumatic diseases resembling inflammatory arthritis. This was not unexpected as lupus is understood to affect the brain in some cases.
Among patients reporting hallucinations, 61% of lupus patients and 34% of other autoimmune rheumatological diseases reported sleep disturbances (mostly nightmares) just before their hallucinations.
Day dreams
Our ex the study It found that greater than 50% of individuals rarely or never report mental health symptoms to their doctors. Although people were often more comfortable talking with our interviewers than with their doctors, we used the word “daymare” to scale back the sense of fear and stigma that many individuals associate with the word “hallucination.” feel about
Patients also felt that “dreaming” was description because hallucinatory experiences were often described as dream-like states “between sleep and waking” and “waking dreams.” Many patients described the word and outline as a “lightbulb” moment for them:
[When] You said the word daydreamer and as you said it just felt, it's not necessarily scary, it's such as you've had a dream and also you're still waking up within the garden … I various things. See, that's how I come out of it and it's like if you get up and also you don't remember your dream and also you're there but you're not there … it's like really Feeling hopeless, the closest thing I can consider is that I feel like I'm Alice in Wonderland.
Many individuals with lupus and other autoimmune diseases can have a protracted and difficult journey to diagnosis. Further understanding of the broader range and form of symptoms may result in less misdiagnosis and higher treatment of those patients. People whose first symptoms of autoimmune disease are psychiatric are particularly susceptible to misdiagnosis and mistreatment, as this rheumatology nurse explained:
I actually have seen [patients] is admitted for an episode of psychosis and lupus will not be screened until someone says, 'Oh I'm wondering if it might be lupus' … however it was months and really difficult. … Especially with young women and learning more that that is how lupus affects some people and it's not antipsychotics that they need, it's like a number of steroids.
Doctors are also short on time, especially with complex diseases like lupus that may affect any a part of the body. One rheumatologist we interviewed said that discussing these symptoms was not a priority.
I hear what you're saying … concerning the nightmares and the hallucinations, and I imagine that, but what I'm saying is that you've got to do it in addition to the same old management of lupus. Can't add.
However, most doctors within the study said they might now start asking about nightmares and other symptoms. Several reported back to the researchers that their patients were now reporting these symptoms commonly and that it was helping them monitor their disease.
Symptoms resembling nightmares are usually not on diagnostic lists, so patients and doctors often don't discuss them. Relying on doctor's observations, blood tests and brain scans to diagnose diseases doesn't work for symptoms which can be latent and haven't yet – and should never – show up on a test.
Our study also highlights the importance of doctor-patient teamwork in identifying, monitoring, and treating these often distressing symptoms.