End-of-life patients sleep more because their bodies conserve energy as vital organs slow down, metabolism decreases, and they become weaker, combined with the sedating effects of pain medications and reduced nutrition, all natural parts of the body shutting down peacefully, often with periods of alertness interspersed. This increased sleepiness is a normal sign of the body's transition, allowing for rest as the body shifts energy to sustain essential functions.
End of life care should begin when you need it and may last a few days or months, or sometimes more than a year. People in lots of different situations can benefit from end of life care. Some of them may be expected to die within the next few hours or days. Others receive end of life care over many months.
Complete loss of consciousness
At the end of life, the body's chemical balance completely changes. The dying person then slips into unconsciousness. This is usually right towards the end, maybe only a few hours or days before death. The person's breathing becomes irregular and may become noisy.
Increased sleep is usual in hospice because the body is reserving limited energy. Terminal illnesses demand much from the body, causing fatigue and excessive sleep.
Tell Them It's Okay to Let Go
First, assure them that while it's normal to want to hold on at the end of life, it's okay to let go. Don't force things, but do remind your loved one of how much you love them. Let them know you're not angry and don't hold any resentment that they're dying.
In the hours before death, most people fade as the blood supply to their body declines further. They sleep a lot, their breathing becomes very irregular, and their skin becomes cool to the touch. Those who do not lose consciousness in the days before death usually do so in the hours before they die.
The “three magic phrases”—you will not be alone, you will not feel pain, we will be okay—struck a chord with me not only as someone who has sat beside dying friends, but as someone who has wondered what I would want to hear if it were me.
When hospice patients sleep extensively, it generally indicates that they are nearing the final phase of life. Increased sleep duration and decreased responsiveness are common as the body slows down and the natural dying process progresses.
This period runs from 3 to 72 hours after death. The early post-mortem phase is most frequently estimated using the classical triad of post-mortem changes – rigor mortis, livor mortis, and algor mortis.
Hospice Isn't About Giving Up
It's not a place to speed up the process of dying. A doctor suggesting hospice does not mean they're giving up on providing care and medical treatment. It's end-of-life care, but this doesn't mean giving up hope. It means shifting focus from curative treatments to comfort and support.
Morphine is an opiate, a strong drug used to treat serious pain. Sometimes, morphine is also given to ease the feeling of shortness of breath. Successfully reducing pain and addressing concerns about breathing can provide needed comfort to someone who is close to dying.
Research suggests that even as your body transitions into unconsciousness, it's possible that you'll still be able to feel comforting touches from your loved ones and hear them speaking. Touch and hearing are the last senses to go when we die.
Because of decreased fluid intake, the person's urine output will naturally decrease. As a result, the urine may become concentrated and “tea” colored. The person may also lose control of urine and bowel function as the muscles in that area begin to relax.
Physical signs of dying
They might close their eyes frequently or they might be half-open. Facial muscles may relax and the jaw can drop. Skin can become very pale. Breathing can alternate between loud rasping breaths and quiet breathing.
But the body tries valiantly. The first organ system to “close down” is the digestive system.
More broadly, characteristics of a bad death can span across areas of physical health (e.g., pain, physical decline and loss of function, and prolonged death), psychological health (e.g., depression, anxiety), spiritual and religious health (e.g., dignity, wishes not being carried out, existential loneliness/suffering) ...
But as death approaches, you may notice some of these changes.
Stage 3: Putrefaction - 4 to 10 days after death
They often respire in the absence of oxygen (anaerobically) and produce various gases including hydrogen sulphide, methane, cadaverine and putrescine as by-products. People might find these gases foul smelling, but they are very attractive to a variety of insects.
“ Some scientists claim that the brain might be active for a short time after someone dies, maybe 7 minutes or more. They're not sure what happens during that time, if it's like a dream, seeing memories, or something else. But if it is memories, then you'd definitely be part of my 7 minutes or hopefully, more. “
They are likely to spend more time sleeping, and will often be drowsy even when they are awake. They may also drift in and out of consciousness. Some people become completely unconscious for periods of time before they die - this could be for a short period or as long as several days.
however at the end of life your muscles start fully relaxing. so all your muscles in your body are all relaxing. including your jaw and mouth and tongue and your throat all these muscles are all relaxing. so your mouth will hang open.
What other signs might there be that death is near? One is 'terminal agitation' or restlessness. This often appears as a need to get out of bed, agitated behaviour or commonly plucking of the sheets or 'knitting' of the hands. They might reach out as if towards something or somebody.
Speak soothing words
Many people reach up or raise their arms near the end of life—it's a common and beautiful part of the journey. Some say it's the soul beginning to lift, reaching toward something beyond.
Phrases like, “I'm always here if you need to talk” or “You're not alone in this” can provide the reassurance they need. The goal is to offer comfort and remind them that they have your unwavering support.