Hospice Patients Sleeping: Understanding The Reasons And Care

Hospice patients sleeping all day is a common occurrence and can be distressing for family members. However, it is usually a normal and expected part of the dying process. As the body prepares for death, energy levels decrease, and the patient may only have enough energy to be awake for short periods. This increased sleep is caused by physical fatigue, medication effects, metabolic changes, decreased nutrition, emotional and spiritual processing, pain avoidance, and the body's natural process of shutting down. While it is natural to want to maximize time with a loved one, trying to keep them awake can increase their discomfort and agitation. Instead, it is recommended to adjust expectations and find new ways to connect that do not require the patient to be fully alert, such as sitting quietly by their bedside, holding their hand, or talking softly to them.

This is a normal part of the dying process

Hospice patients sleeping all day can be a normal part of the dying process. This is because the body is preparing for death, and energy levels decrease dramatically. The patient's body may be working hard to manage symptoms and fight illness, which can be exhausting. Sleep allows the conservation of limited energy.

Additionally, medication effects can also cause increased sleep. Pain medications and other drugs used for symptom management often have sedating effects. This may be a feature of the medication or a side effect. Metabolic changes can also cause increased sleep, as the body's metabolism slows down when organs begin to shut down.

Decreased nutrition can also result in more sleep. This is common towards the end of life, as reduced food and fluid intake results in less energy. Changes in appetite may also be a side effect of medication.

Emotional and spiritual processing can also play a role. Sleep may provide a way for the dying person to withdraw and process their emotions about death. Sleeping can also be a way to escape physical discomfort and avoid pain.

Finally, increased sleep is often part of the body's natural process of shutting down as death approaches. While it can be distressing for family members, it's important to understand that it's a normal part of the dying process.

The patient's body is working hard to fight illness

Hospice patients may experience an increase in sleep as their body works hard to manage symptoms and fight illness, which can be exhausting. This is a normal part of the dying process and is the body's natural response to conserve limited energy.

The body's metabolism slows down as vital organs begin to shut down, leading to increased fatigue and sleep. This is further exacerbated by a decrease in nutrition, as reduced food and fluid intake results in less energy. Medications can also play a role, as pain medications and other drugs used for symptom management often have sedating effects.

Additionally, sleep may provide emotional and spiritual processing time for the patient, allowing them to withdraw and come to terms with their emotions about death. It can also be a way to escape physical discomfort and avoid pain.

While increased sleep is a typical part of the end-of-life process, there are situations where you should alert the hospice team. If the change in sleep patterns is sudden or accompanied by other new symptoms, it is important to seek medical advice. Similarly, if the patient seems to be in pain or distress while sleeping, or if they are difficult to rouse, it is crucial to consult with the hospice care providers.

Understanding the reasons behind the increase in sleep and knowing what to expect can help provide comfort and support to the patient and their loved ones during this challenging time.

Medication can cause drowsiness

Medication can be a vital part of hospice care, helping to relieve common end-of-life symptoms such as pain, shortness of breath, anxiety, and nausea. However, some medications can cause drowsiness as a side effect.

For example, Lorazepam, the second most commonly prescribed hospice medication, can cause drowsiness, dizziness, tiredness, weakness, and blurred vision. It is used to treat anxiety, agitation, shortness of breath, and insomnia. Other possible side effects of Lorazepam include dry mouth, diarrhea, constipation, nausea, changes in appetite, restlessness, difficulty urinating, and sexual dysfunction.

Another medication that may cause drowsiness is Haloperidol (Haldol), an antipsychotic drug used to treat terminal agitation and delirium. Its side effects include confusion, dizziness, fainting, a fast or pounding heartbeat, flu-like symptoms, high fever, restless or rigid muscles, seizures, sweating, and tremors. Haloperidol should not be given to patients with seizure disorders or, generally, to people with Parkinson's disease.

Fentanyl is a strong painkiller used in hospice care to relieve severe, ongoing pain, such as that caused by cancer. It can cause extreme drowsiness, as well as confusion, decreased urge to breathe, difficulty breathing or swallowing, fainting, and slow or shallow breathing. Other possible side effects include agitation, changes in heartbeat, diarrhea, dizziness, fever, hives, hallucinations, loss of appetite, muscle stiffness, nausea, seizures, sweating, vomiting, and weakness.

Dexamethasone is a steroid with multiple purposes, including pain relief, reducing swelling, increasing appetite, and relieving nausea. Its side effects can include insomnia, restlessness, depression, anxiety, and easy bruising. However, if the medication is stopped abruptly, it can cause a range of serious reactions, including drowsiness, confusion, headache, fever, joint and muscle pain, and weight loss.

While medication can sometimes be the cause of drowsiness in hospice patients, it is important to remember that increased sleep is also a normal part of the dying process. The patient's body may be working hard to manage symptoms and fight illness, which can be exhausting. Additionally, metabolic changes and decreased nutrition can lead to increased fatigue and sleep.

Emotional and spiritual processing

Creating a Peaceful Environment

It is essential to provide a calm and peaceful environment for the patient. This includes maintaining a quiet space, using soft lighting, and incorporating comforting scents. Soft music and gentle touch can also enhance the patient's environment. It is important to ensure the patient feels safe and supported.

Encouraging Emotional Expression

Encourage the patient to express their emotions and process their feelings about death. Provide opportunities for them to talk about their worries, fears, and spiritual concerns. Offer emotional support and, if needed, facilitate access to professional counselling or spiritual guidance.

Facilitating Meaningful Connections

Even if the patient is sleeping most of the time, meaningful connections can still be fostered. Sit quietly by their bedside, hold their hand, and talk softly to them. Share memories, express your love, and reminisce about happy times. Involve other family members to allow everyone a chance to connect and provide support.

Respecting the Patient's Wishes

It is crucial to respect the patient's wishes and honour their preferences. If they prefer to sleep, allow them to rest. If they want to engage in conversation or share their thoughts, be present and listen attentively. It is important to follow their lead and respect their emotional and spiritual needs.

Adjusting Expectations

As a caregiver or loved one, it is essential to adjust your expectations. Understand that the patient's energy levels are decreasing, and they may only have the capacity for brief interactions. Instead of trying to keep them awake, find ways to connect that respect their need for sleep. This may include soft music, gentle touch, or simply sitting quietly by their side.

Seeking Professional Support

If the patient is experiencing emotional or spiritual distress, consider seeking professional support. End-of-life care can be challenging, and hospice teams often have resources to help. This may include access to psychologists, counsellors, faith leaders, or spiritual advisors. Additionally, cognitive-behavioural therapy (CBT) can be beneficial for processing emotions and coping with end-of-life concerns.

It's distressing for family members

Watching a loved one go through the end-of-life process in hospice care can be emotionally challenging for family members. Seeing a hospice patient sleep all day can be distressing and confusing for family members. This shift can be particularly difficult if the family members are used to chatting and visiting with the patient.

Increased sleep is a normal part of the dying process for many people. The patient's body may be working hard to manage symptoms and fight illness, which can be exhausting. Sleep allows the conservation of limited energy. The patient's body is strained by the progression of their disease, and they may struggle to eat or drink, which contributes to their growing weakness and declining health.

Additionally, pain medications and other drugs used for symptom management often have sedating effects. Metabolic changes, such as a slowing metabolism and decreased nutrition, can also lead to increased fatigue and sleep. Emotional and spiritual processing, as well as pain avoidance, can also contribute to increased sleep towards the end of life.

It is important for family members to understand that increased sleep is typically a normal and expected part of the dying process. While it can be distressing, family members can adjust their expectations and find new ways to connect with and provide comfort to the patient. They can sit quietly by their bedside, hold their hand, talk softly to them, read aloud from a favourite book, play gentle music they enjoy, and reminisce about happy memories.

Family members can also create a peaceful environment with soft lighting, gentle music, and comforting scents. They can share memories and express their love, even if the patient is asleep. Involving other family members in care can also help, allowing everyone a chance to connect. Taking photos or videos, if the patient is comfortable, can also help preserve memories.

Remember that the quality of time spent with a loved one is often more important than the quantity. While it can be difficult to accept, increased sleep in a hospice patient may allow for a peaceful and comfortable transition as their body prepares for death.

Frequently asked questions