Watching your parent or loved one go through the end-of-life process in hospice care can be an emotionally challenging experience. One common change that often occurs is an increase in sleep. This shift can be confusing and distressing for family members.

Increased sleep is a normal part of the dying process for many people. Understanding the reasons behind this change and how to respond can help you provide comfort and support during this difficult time.

Why Sleep Increases Near the End of Life

There are several reasons why a person in hospice care may sleep more as they approach the end of life:

1. Physical fatigue: 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.

2. Medication effects: Pain medications and other drugs used for symptom management often have sedating effects. This may be a feature of the medication, or may be a side effect, so it may be worth discussing with the patient’s health care provider if you have concerns.

3. Metabolic changes: At the end of life, as organs begin to shut down, the body's metabolism slows, leading to increased fatigue and sleep.

4. Decreased nutrition: Reduced food and fluid intake is common near the end of life, resulting in less energy. Changes in appetite may also be a side effect of medication, so, once again, check with the doctor to clarify.

5. Emotional and spiritual processing: Sleep may provide a way for the dying person to withdraw and process their emotions about death.

6. Pain avoidance: Sleeping can also be a way to escape physical discomfort.

7. Natural part of dying: Increased sleep is often part of the body's natural process of shutting down as death approaches.

Is It Normal for Someone in Hospice to Sleep So Much?

While it can be alarming to see your parent sleeping most of the time, this is typically a normal and expected part of the dying process. As the body prepares for death, energy levels decrease dramatically. Your parent may only have enough energy to be awake for short periods.

This increased sleep does not necessarily mean your parent is unconscious or unaware. Many people in this stage drift in and out of consciousness. They may be able to hear and be aware of their surroundings even when their eyes are closed or they seem unresponsive.

Should You Try to Keep Your Parent Awake?

It's natural to want to maximize the time you have left with your parent. However, trying to keep them awake when their body is telling them to sleep can actually increase their discomfort and agitation. Instead of fighting against this natural process, it's better to adjust your expectations and find ways to connect that don't require your parent to be fully alert.

Some ways to maintain connection while respecting your parent's need for sleep include:

• Sitting quietly by their bedside, holding their hand

• Talking softly to them, even if they don't respond

• Reading aloud from a favorite book

• Playing gentle music they enjoy

• Reminiscing about happy memories, even if it's just to yourself

• Telling them you love them and remembering things they did that were deeply meaningful to you

Remember that your presence itself can be deeply comforting, even if your parent isn't able to interact much.

How Much Sleep Is Too Much? When Should You Be Concerned?

While increased sleep is normal, there are some situations where you should alert the hospice team:

• If the change in sleep patterns is very sudden and accompanied by other new symptoms

• If the change seems related to a change in medication and drowsiness or sleepiness was not listed as a potential side effect

• If your parent seems to be in pain or distress while sleeping

• If they are difficult to rouse even for short periods

• If you notice changes in breathing patterns during sleep

• If you have any concerns or questions about your parent's condition

The hospice team can help you assess whether the increased sleep is part of the expected progression or if adjustments to the care plan are needed.

Understanding the Stages of Decreased Consciousness

As death approaches, your parent may go through several stages of decreased consciousness:

1. Drowsiness: Your parent may sleep more but can still be awakened.

2. Difficulty staying awake: When roused, they may only stay awake for short periods.

3. Semiconscious: Your parent may drift in and out of consciousness, responding only to voices or touch.

4. Unresponsive: In the final hours or days, your parent may enter a state where they cannot be roused but may still be able to hear.

Knowing these stages can help you understand what to expect and how to adjust your interactions accordingly.

Making the Most of Remaining Time

Even if your parent is sleeping most of the time, there are still ways to make the most of your remaining time together:

• Use periods of wakefulness for meaningful conversations or activities

• Create a peaceful environment with soft lighting, gentle music, and comforting scents

• Share memories and express your love, even if your parent is asleep

• Involve other family members in care, allowing everyone a chance to connect

• Take photos or videos if your parent is comfortable with it

• Write down thoughts or memories to share later with family

Remember that quality of time often matters more than quantity in these situations.

The Gift of Peaceful Passing

While it can be difficult to accept, your parent's increased sleep may be a gift in its own way. It can allow for a peaceful, comfortable transition as the body prepares for death. By understanding and accepting this process, you can focus on providing comfort and love during this important time.

When a parent in hospice care begins to sleep most of the time, it's a sign that the end of life is approaching. While this can be distressing for family members, it's important to understand that it's a normal part of the dying process for many people. Increased sleep allows the body to conserve energy and can provide a peaceful transition.

Rather than fighting against this natural process, family members can adjust their expectations and find new ways to connect and provide comfort. By understanding the reasons behind increased sleep, knowing what to expect, and focusing on quality interactions, you can make the most of the time remaining with your parent.

Remember that the hospice team is there to support both the patient and their family. Don't hesitate to reach out with any questions or concerns. While this is undoubtedly a challenging time, it can also be an opportunity for deep connection, healing, and peaceful closure.