Occasional nightly delirium during mild fever -- what gives?

March 24, 2011 5:05 PM

Occasional nightly delirium during mild fever -- what gives?

On occasion, usually when I have a fever, I wake up in the middle of the night in a state of delirium. My thought processes typically take the form of whatever it was that I was doing that day; for instance, if I was playing Scrabble, I would feel compelled to "form columns" by rolling around in bed. It really feels like the way my brain thinks is temporarily overwritten. I'm typically fully aware that these thought processes aren't real, but whenever I try to ward them off, they come back almost immediately. The only way to fix this is to turn on the light and wait for a bit, or to simply wait until morning.

Another example: I woke up once thinking that my thoughts were compartmentalized into a series of "bubbles", and that I could only think with one "bubble" at a time. Yes, it doesn't make a lot of sense when I put it like that, but that's how I felt my brain was working when it happened, and I was freaking out for a good while until it passed.

So, what gives? I'm not particularly worried about my health as this happens very infrequently, but I'd feel a little less insane if I knew I wasn't the only one experiencing this.

posted by archagon to health & fitness (14 answers total)

I had something like this happen to me with a flu I had just a couple of weeks ago, and I don't know if it was lack of sleep or the robotussin or the fever, but I woke up the middle of a night in a cold sweat, and my thoughts were completely disordered. I'd almost call it 'word salad'. Just random strings of thoughts that made absolutely no sense and also seemed to be often work-related. I ended up putting some music on to distract me and go back to sleep and I was fine in the morning, but it was definitely a little scary while it was happening.
posted by empath at 5:15 PM on March 24, 2011

Yep, definitely. I'm glad to hear that I'm not alone. Stress also brings this on.
posted by rustcellar at 5:19 PM on March 24, 2011

It's been years since this happened to me, but I have experienced this on numerous occasions as a kid. When I was a teen I fell asleep during a fever while reading the novel "Jaws," and woke up in a delirium thinking I was about to get eaten by sharks. I've had delirious episodes during fevers about being tied to train tracks, lost in the middle of the ocean, etc. It's horrible. The common thread for me seems to be a horrible sense of helplessness. It doesn't matter that someone is sitting there consoling me.

The most recent time -- probably twenty years ago -- I fell asleep in a very hot bedroom and woke up sweaty and mildly delirious. It wasn't as profound as the others, but there was a definite feeling of dread and horror. I turned on the tv and I remember seeing a news program about some South American soccer fans who killed a goalie(?) who failed to block a goal and it seemed unspeakably horrible and totally in tune with the sense of horror I was feeling.

The one thing my mom figured out would snap me out of it was to put me on the phone with my dad. Something about being on the phone with someone seemed to bring me back to reality.
posted by jayder at 5:25 PM on March 24, 2011

Oh, and the feeling of being locked into some meaningless dream-logic? Yes, I've experienced that, too. Really weird. It's more often caused, for me, by sleep deprivation.
posted by jayder at 5:27 PM on March 24, 2011

I had the same sort of thing happen once when I had the flu, during the part of it when I had the highest fever. It was during the day rather than at night like you had. I can't remember what my thoughts were exactly (this happened years ago) but they definitely didn't make sense, and I was aware they didn't make sense. It was to the point where I decided if it got any worse I was going to call an ambulance, but thankfully the effect went away pretty quickly.
posted by FishBike at 5:40 PM on March 24, 2011

"Locked into some meaningless dream-logic" is a great way of describing it.
posted by archagon at 5:59 PM on March 24, 2011

This happened to me frequently during a period where I was working crazy hours- 60 or so a week. My sleep was what I describe as "feverish" because of the symptoms (the columns thing you mentioned resonates with a lot of my experience), but I don't rightly know if I had a fever. Obviously for me it was stress-related. I wasn't sleeping much, My work was both physically and mentally demanding, and I didn't have much else going on at the time. On top of that, this delirium happened so frequently at the time that the quality of what sleep I did get was really poor, since I was half awake for so much of it.

Doesn't sound like it's just you!
posted by sunshinesky at 6:17 PM on March 24, 2011

hell, I was working more than 60 hour weeks, come to think of it! Some were closer to 84. Wow....
posted by sunshinesky at 6:18 PM on March 24, 2011

Oh wow, I was going to ask the same question 2 months ago when I had the flu but I didn't have the words. I've only had this twice in my life and both times in the last year. And I wanted to find out if it was a symptom of the particular flu that is going around this winter. Because it is very distinct - like you say - fever and then dreaming about THINKING.

Favoriting this thread.
posted by cda at 6:23 PM on March 24, 2011

I don't have the answer, but this happens to me literally everytime I get a cold or infection with even a slight fever. I find it bizarre and unsettling and maddening, and am relieved to know that it happens to other people.
posted by scrute at 8:15 PM on March 24, 2011 [1 favorite]

This question sparked my interest. Illness in general seems to affect one's mental state. I've had an awful cold all day and I can definitely say the effects are not unlike being a little bit high on something - I felt lightheaded and easily amused by things. My sister told me a story of having the flu as a kid and thinking she was part of an Olympic race.

I tried to find some info on why this happens, but the results were pretty vague. All I could find was that "fever interferes with metabolic processes" and in particular a rapid onset of a fever is most likely to cause delirium. The latter might explain why you'd experience it with a lower grade fever, but I don't know what specifically happens in the brain.
posted by ktpetals at 8:30 PM on March 24, 2011

After a lot of Googling, I found some interesting things:

http://psychcentral.com/news/2008/06/10/why-mental-lethargy-when-sick/2434.html

"A recent study examines why it is hard to concentrate when you feel sick. This problem very likely reflects the effects of substances that are released by immune cells in the brain... the immune cells, called inflammatory cytokines, help your body cope with infection... chemical messengers released in the blood stream to combat infection can influence motivational centers in the brain leading to ‘psychomotor’ features of sickness."

In other words, cytokines seem to be what makes you have all the lethargic blah feelings you get when you're sick. A couple of abstracts I found suggested that they're related to delirium:

"According to the inflammatory hypothesis, increased cerebral secretion of cytokines due to a wide range of physically stressful events plays an important role in the occurrence of delirium. Since cytokines can influence the activity of various neurotransmitter systems, these mechanisms may interact. Also, more fundamental processes like intraneuronal signal transduction, second messenger systems that at the same time use neurotransmitters as first messengers and play an important role in their synthesis and release, may be disturbed. Furthermore, severe illness and physiologic stress may give rise to modification of blood-brain barrier permeability, the sick euthyroid syndrome with abnormalities of thyroid hormone concentrations, and increased activity of the hypothalamic-pituitary-adrenal axis. These circumstances possibly also contribute to changes in neurotransmitter synthesis and release of cytokines in the brain, and consequently to the occurrence of delirium."

http://www.ncbi.nlm.nih.gov/pubmed/9894732

"There is compelling evidence that acute peripheral inflammatory stimulation induces activation of brain parenchymal cells, expression of proinflammatory cytokines and inflammatory mediators in the central nervous system. These neuroinflammatory changes induce neuronal and synaptic dysfunction and subsequent neurobehavioural and cognitive symptoms. "

http://www.ncbi.nlm.nih.gov/pubmed/20309566

I guess the nutshell version would be: you get sick, cytokines are released that interact with normal brain functions in a way that makes you feel all ooky. There was something else I read that suggested that higher levels of cytokines increase one's feeling of ookiness.
(I majored in English! Can you tell?)
posted by ktpetals at 9:28 PM on March 24, 2011

It happens to me when I have really bad fevers.

And sometimes when I drink too much.

Dreams are weird... Fever is an immunological response to an infection (usually viral); neurotransmitter signaling still plays by the "lock and key" model; if your body is in fever mode (warmer than usual), that'll also extend to your brain - increased temperatures will change the binding affinity of neurotransmitters with their receptors.

Mostly stuff is still the same.

But there's going to be very subtle alterations. It happens to just about everybody. Bad fever ~ weird dreams.
posted by porpoise at 9:51 PM on March 24, 2011

It happens to me when I'm sick or sleep deprived. And when I'm sleep deprived, it's usually for a reason--just imagine the "dream logic" being a math or programming problem. I wonder if this has anything to do with dreaming about tasks you perform repeatedly. When I was 9, I pretty much spent an entire summer playing Tetris. I had dreams about "being" a game of Tetris. Those dreams felt similar to the sorts of experiences being shared here.

I also have to just get up, turn on the lights, and drink some water to make these feelings go away. Apparently, trying to wake me while I'm having one of these dreams results in a very disoriented, angry me--I'll yell and thrash around and not remember it in the morning.
posted by thack3r at 9:08 AM on March 25, 2011