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Nightmares can be unpleasant, but for most people they are completely normal. However, recent research has shown that they could be precursors to autoimmune diseases such as lupus. The study, published in The Lancet's eClinicalMedicine journal, examined the early warning signs of a possible recurrence of autoimmune diseases. Researchers surveyed 676 lupus patients and 400 physicians and conducted more than 100 in-depth interviews. Researchers interviewed patients about the neurological and psychological symptoms they experienced and the timing of the onset of these symptoms in relation to the initial onset of the disease. These include symptoms such as mood swings, hallucinations, tremors and fatigue. The researchers also asked whether there was a typical pattern of symptoms when patients were about to have an attack. Many patients were able to describe symptoms that occurred immediately before the attack. Although the patterns varied from person to person, the pattern of relapse was often similar for each person. Patients often knew which symptoms indicated that their disease was getting worse.

Nightmares that precede autoimmune diseases have also been observed in other neurological diseases. Descriptions of flame-related nightmares in this study often included being attacked, trapped, crushed, or falling. Many were very upset. One person described them as "terrible, murderous, like people being skinned, horrible." Another important finding was that these nightmares often occurred before the illness worsened, particularly in people who subsequently experienced hallucinations as part of their clinical picture. This possibility is higher in patients with lupus than in other rheumatic diseases such as inflammatory arthritis. This was not unexpected as lupus affects the brain in some cases. Of the patients who also reported hallucinations, 61% of lupus patients and 34% of other autoimmune rheumatic diseases reported increased sleep disturbances (mainly nightmares) immediately preceding the hallucinations. Previous research has shown that more than 50 percent of people rarely or never report mental health symptoms to their doctor. Although people typically feel more comfortable speaking to an interviewer than a doctor, researchers use the term "daydreaming" to reduce the fear and stigma that many people have toward the word "hallucination."

The patient also felt that “daydreaming” was an appropriate description since hallucinatory experiences are often described as a sleep state such as “between sleep and wakefulness” or “waking dreams.” Many patients say that these words and explanations were an eye-opener for them. You are dreaming and sitting awake in the garden... you see all sorts of things as if you had just come from a dream, and when you wake up you don't remember the dream and you are there. Like I'm not there... I feel really lost and the best thing I can imagine is feeling like Alice in Wonderland. Many people with lupus and other autoimmune diseases can face a long and difficult road before they are diagnosed. A better understanding of the wide range of symptoms and types experienced by these patients can reduce misdiagnosis and enable better treatment. As this rheumatology nurse explained, people whose initial symptoms of autoimmune disease are psychological are likely to be misdiagnosed and poorly treated. I've seen [patients] admitted to the hospital with psychotic episodes, but it wasn't until someone told them, "Oh, maybe it's lupus..." but that took months and it was very difficult. Particularly in women, we find that some people are affected by lupus and they don't need an antipsychotic, but rather something like a high dose of steroids.

Doctors' time is also at a premium, especially with a complex disease like lupus, which can affect any part of the body. A rheumatologist said discussing these symptoms was not a priority. "I hear what you're saying about the nightmares and hallucinations, and I believe that too, but I'm saying that it's inconceivable that it's anything more than everyday treatment for lupus, but most of the doctors in the study," he said and added that they are now starting to ask about nightmares and other symptoms. Some told researchers that their patients regularly reported these symptoms, which helped them manage their illness. Symptoms such as nightmares are not on the diagnostic list, so patients and doctors do not talk about them. Relying on medical observations, blood tests, and brain scans to diagnose diseases based on invisible symptoms that haven't and may never show up on tests doesn't work. The study also emphasizes the importance of teamwork between doctor and patient in identifying, monitoring and treating these often distressing symptoms.