Colin Snow
Sleep is an essential part of life, and its importance is highlighted in the process of dying. As a person nears death, their body experiences various changes, including decreased appetite, vital sign changes, muscle weakness, and increased sleeping. This is because the body's need for energy decreases, and it prioritises survival by directing limited resources to vital organs. While sleep loss may not directly cause death, it can have negative consequences on health and increase the risk of accidents and injuries, which can be life-threatening.
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What You'll Learn
Sleep and terminal illness
Sleep is essential for our well-being. It is a complex function that impacts other essential bodily functions such as controlling temperature and hormone levels. As death approaches, the body's need for sleep increases while physical activity decreases. This is because the body doesn't have the energy for activity. The heart becomes less able to pump oxygen-rich blood throughout the body, and without enough oxygen, the body's cells don't have the energy needed to keep a person awake and active for long periods.
People with terminal illnesses commonly experience sleep problems, which can be distressing for both the patient and their loved ones. These sleep issues can take various forms, including insomnia, disorders of the sleep-wake cycle, and excessive daytime sleepiness. The quality and quantity of sleep can significantly impact a person's well-being and quality of life. Sleep problems can make physical symptoms and difficult emotions harder to manage and can lead to low mood and anxiety.
There are many factors that can contribute to sleep problems in terminally ill patients, including restless leg syndrome, bladder or bowel symptoms, anxiety and worries, reduced activity during the day, medication, respiratory problems, caffeine, nicotine, or alcohol consumption, and environmental conditions such as noise and light levels.
As death approaches, a person's sleep patterns may change further, with sudden bursts of energy or restlessness following long periods of sleep. They may also experience periods of unconsciousness, similar to a coma or dream state. Despite being in an unconscious state, research suggests that people may still be able to feel comforting touches and hear the voices of their loved ones.
To support someone with a terminal illness who is experiencing sleep problems, there are several practical things that can be done. These include maintaining a consistent sleep schedule, avoiding naps during the day, encouraging physical activity, ensuring the person is comfortable and their symptoms are well-controlled, and creating a calm and quiet sleeping environment. Additionally, relaxation techniques such as deep breathing, listening to music, or taking a bath can be helpful. It is also important to address any underlying causes of sleep problems, such as anxiety or pain, and seek support from healthcare professionals.
In the final hours before death, a person's organs shut down and their body stops working. They may experience more prolonged periods of unconsciousness and spend most of their time sleeping. It is important to continue speaking to them in a calm and quiet voice, as hearing is often the last sense that a person loses.
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Sleep and heart health
Sleep is essential to health, right through to your heart. Getting good sleep is critical for your heart health. Sleep helps your body repair itself, and getting enough good sleep helps you function normally during the day. Most adults need at least 7 hours of sleep each night, with 7-9 hours being the recommended amount. However, more than 1 in 3 American adults do not get the recommended amount of sleep. While this may be fine for a day or two, not getting enough sleep over time can lead to serious health problems, including heart problems.
How Sleep Impacts the Heart
Poor sleep can affect the heart indirectly by influencing our choices about food and exercise. Research shows that not sleeping well may lead to increased food cravings and a gravitation towards less heart-healthy comfort foods high in saturated fat and sugar. When you don't eat well, you don't sleep well, and this relationship works both ways. People who do not get enough sleep are also more likely to develop high blood pressure, which increases the risk of heart disease.
Lack of sleep also promotes inflammation. While inflammatory cells protect you from illnesses, too many that stay for too long can result in chronic inflammation and, eventually, heart disease. Research shows that even relatively mild sleep problems can cause inflammation in the endothelial cells that line the veins, which could significantly contribute to the development of cardiovascular disease.
Sleep Disorders and Heart Health
Sleep disorders are conditions that affect the quality, timing, and amount of sleep. There are more than 80 different sleep disorders, with insomnia, narcolepsy, restless leg syndrome, and sleep apnea being the most common. Sleep disorders cause sleep disruptions and make it difficult to get the sleep you need to stay healthy. Sleep disorders have been linked to a higher risk of cardiovascular disease. Poor sleep can cause major cardiovascular disease risk factors, including obesity, high blood pressure, and diabetes. Insufficient or irregular sleep can negatively influence diet, stress, and other lifestyle factors that can raise the risk of cardiovascular disease.
Consistency of Sleep
Consistency of sleep is vital to heart health. Recent research on sleep and heart health shows that those with the most irregular sleep schedules were nearly twice as likely to develop heart disease as those with more regular sleep patterns. It is not known why going off a regular sleep schedule affects the heart, but sleep inconsistency may disturb the body's circadian rhythms. Heart rate, blood pressure, and other cardiovascular functions vary with the time of day and may become disrupted by inconsistent sleep.
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Sleep and mental health
Sleep is closely connected to mental and emotional health. Research has shown that sleep is linked to depression, anxiety, bipolar disorder, and other conditions. While the exact mechanisms are still being studied, it is clear that there is a bidirectional relationship between sleep and mental health.
Brain Activity and Sleep
Brain activity fluctuates during sleep, increasing and decreasing during different sleep stages that make up the sleep cycle. Each stage plays a role in brain health, allowing activity in different parts of the brain to ramp up or down and enabling better thinking, learning, and memory. Research has also shown that brain activity during sleep has profound effects on emotional and mental health.
Sleep Deprivation and Mental Health
Sleep deprivation can increase the risk for mental health disorders. While insomnia can be a symptom of psychiatric disorders, it is now recognized that sleep problems can also contribute to the onset and worsening of different mental health problems, including depression, anxiety, and even suicidal ideation. Sleep deprivation studies show that otherwise healthy people can experience increased anxiety and distress levels following poor sleep.
Sleep and Specific Mental Health Problems
The way that sleep and mental health are intertwined becomes even more apparent when reviewing the links between sleep and specific mental health conditions.
#### Depression
It is estimated that over 300 million people worldwide have depression, a type of mood disorder marked by feelings of sadness or hopelessness. Around 75% of depressed people show symptoms of insomnia, and many people with depression also suffer from excessive daytime sleepiness and hypersomnia, which is sleeping too much. Growing evidence suggests that poor sleep may induce or exacerbate depression.
#### Seasonal Affective Disorder
Seasonal Affective disorder is a subtype of depression that most often affects people during times of the year with reduced daylight hours. People with seasonal affective disorder tend to sleep too much or too little or experience changes to their sleep cycles.
#### Anxiety Disorders
Anxiety disorders have a strong association with sleeping problems. Worry and fear contribute to a state of hyperarousal in which the mind is racing, and hyperarousal is considered to be a central contributor to insomnia. Sleep problems may become an added source of worry, creating anticipatory anxiety at bedtime that makes it harder to fall asleep. Research has found an especially strong connection between PTSD and sleep. People with PTSD frequently replay negative events in their mind, suffer from nightmares, and experience a state of being on alert, all of which can interfere with sleep.
#### Bipolar Disorder
In people with bipolar disorder, sleep patterns change considerably depending on their emotional state. During manic periods, they usually feel less need to sleep, but during depressed periods, they may sleep excessively. There is also evidence that sleeping problems induce or worsen manic and depressive periods.
#### Schizophrenia
People with schizophrenia are more likely to experience insomnia and circadian rhythm disorders. Poor sleep and symptoms of schizophrenia may be mutually reinforcing, so there are potential benefits to stabilizing and normalizing sleep patterns.
#### Attention-Deficit/Hyperactivity Disorder (ADHD)
Sleeping problems are common in people with ADHD. They may have difficulty falling asleep, frequent awakenings, and excessive daytime sleepiness. Sleep difficulties associated with ADHD have been studied primarily in children but have been found to affect adults as well. There is evidence of a bidirectional relationship between sleep and ADHD. In addition to being a consequence of ADHD, sleep problems may aggravate symptoms like reduced attention span or behavior problems.
#### Autism Spectrum Disorder (ASD)
Children and adolescents with ASD have a higher prevalence of sleep problems, including insomnia and sleep-disordered breathing. These issues tend to be more persistent than sleeping problems in children without ASD, and they can contribute to a worsening of symptoms and quality of life for people with the condition. Addressing insomnia and other sleep disturbances is an important component of care as it may decrease excessive daytime sleepiness as well as other health and behavior problems in people with ASD.
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Sleep and accidents
As people approach death, they tend to sleep more and engage in less physical activity. This happens because the body does not have the energy for activity. The heart becomes less able to pump oxygen-rich blood throughout the body, and without enough oxygen, the body's cells do not have the energy to keep the person awake and active for long periods.
This increased sleep can lead to accidents and injuries that can be life-threatening. For example, getting less than seven hours of sleep over a 24-hour period puts a person at higher risk of being in a car accident or causing one. Sleep deprivation can also lead to inattentiveness and loss of concentration, which can be dangerous, especially when operating heavy machinery or driving.
Work accidents and injuries are more likely to occur overnight, and shift workers are at a higher risk of experiencing the dangerous effects of sleep deprivation. Some major work-related disasters have been partly blamed on sleep deprivation, such as the Exxon Valdez oil spill in Alaska and the Chernobyl nuclear disaster.
Additionally, parasomnias, or disruptive sleep disorders, can lead to fatal accidents if the sleeping person unknowingly engages in dangerous activities like walking into traffic or injuring themselves. These disorders include sleepwalking, REM behavior disorder, and status dissociatus. While rare, these disorders can have fatal outcomes.
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Sleep and grief
Grief is a difficult and highly individual process that a person may go through after losing a loved one or experiencing another trauma. It can cause a range of reactions, including shock, denial, anxiety, anger, sadness, and loss of sleep and appetite.
How Grief Affects Sleep
Grief is one of the most common causes of sleep issues, with many people experiencing insomnia during the grieving process. Insomnia is a sleep disorder characterised by trouble falling asleep, staying asleep, or getting quality sleep. When grieving, a person may experience chronic insomnia, defined as trouble sleeping at least three nights a week for a minimum of three months.
Research shows that poor sleep quality is associated with an increased risk of developing complicated grief, and vice versa. Complicated grief, also known as prolonged grief disorder or traumatic grief, is characterised by intense and long-lasting grief symptoms, even after six months have passed. It is associated with various symptoms, including recurrent emotional pain, preoccupation with the deceased, anger over their death, avoidance of reminders, loss of trust in others, and a sense of having lost part of oneself.
Individuals with complicated grief often experience sleep problems, with 91% reporting sleep issues and 46% specifically attributing their sleep difficulties to their grief. Additionally, those who have sleep complaints during bereavement are more likely to develop complicated grief, demonstrating the bidirectional relationship between sleep and grief.
How to Cope with Grief-Related Sleep Issues
Therapeutic approaches targeting both grief and sleep issues are often recommended to alleviate symptoms. This may include a combination of psychotherapy and medication. Hypnotic medications may be prescribed to relieve insomnia and complicated grief symptoms, while antidepressants, especially when combined with complicated grief therapy (CGT), have been shown to improve sleep quality. Cognitive behavioural therapy (CBT) and interpersonal psychotherapy have also been effective in relieving complicated grief symptoms, although they may not always resolve sleep quality issues.
- Create a routine: Establish a predictable pattern of eating, sleeping, and activity to promote rest.
- Set a bedtime: Stick to a consistent bedtime and wake-up time to regulate your body's sleep-wake cycle.
- Remove distractions: Eliminate distractions from your bedroom, such as televisions or smartphones, as the blue light from screens can disrupt sleep.
- Optimise your bedroom: Use blackout curtains, white noise machines, and proper ventilation to create a comfortable sleeping environment.
- Exercise: Engage in daily movement or walking, avoiding strenuous exercise close to bedtime.
- Avoid sleep disruptors: Refrain from consuming large meals, alcohol, or caffeine close to bedtime, as they can interfere with sleep.
While grieving, it is essential to be patient and compassionate with yourself. Give yourself time to navigate the grieving process and seek support from friends, family, or a doctor if needed. By implementing lifestyle modifications and seeking appropriate treatment, you can improve your sleep quality and overall mental and physical health during this challenging time.
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Frequently asked questions
As a person approaches death, their body doesn't have the energy for activity. Their heart becomes less able to pump oxygen-rich blood throughout their body, and their vital signs may change. They may experience a decreased appetite, increased sleeping, and difficulty breathing.
Signs that someone is close to death include decreased appetite, vital sign changes, muscle weakness, and increased sleeping. They may also experience confusion, hallucinations, and changes in their breathing patterns.
While it is rare, prolonged and recurrent sleep deprivation can lead to death. Sleep deprivation increases the risk of accidents and health problems that can be fatal, such as diabetes, heart disease, and obesity. Extremely uncommon disorders such as fatal familial insomnia or sporadic fatal insomnia can also cause death from a lack of sleep.
