It has been observed that at times, dying patients tend to exhibit unsettled behavior due to delirium or terminal restlessness prior to death.
In this state, the individuals become restless due to unknown reasons and tend to have ‘nearing death awareness’.
Most patients claim to have visions of religious figures, vaporous presences, deceased friends or relatives, convoluted speech in visionary language about some sort of travel or transition, and so on.
This phenomenon cannot be generalized, though, as some dying patients experiencing the deathbed phenomenon have peaceful deaths whereas others with troublesome terminal anxiety experience anguished death.
It is believed that there are two phases that can be perceived before the time of death. The first phase is called “pre-active phase of dying” and the second phase is called “active phase of dying”.
On an average, the first phase tends to last for about two weeks. The second phase, on the other hand, is likely to last for almost three days or so. However, there is no fixed duration for the two.
Usually, the pre-active phase is characterized by confusion, restlessness, social withdrawal, lethargy, decreased consumption of foods and fluids, edema, visions of past dead relatives or friends, etc.
Furthermore, signs and symptoms of the active phase of dying include severe agitation, hallucinations, pauses in breathing (apnea), dramatic changes in the breathing pattern, fluid buildup in lungs causing a gurgling sound while breathing (read about this gurgling sound called the Death Rattle at Quality of Life Care website), coma, semi-coma, cold feet and hands, jaw drop, and so on.
It is believed that the deathbed hallucinations are caused by dying brain due to oxygen deprivation, chemical imbalances, metabolic changes, etc. More often than not, it is suggested to treat terminal restlessness by sedation.
However, there are some people from the medical field itself who believe that as the visions are not chaotic and in fact, have similar themes in most cases, they cannot be mere hallucinations.
Moreover, they are different than those reported by patients suffering from mental illnesses.
You may read about delirium and terminal restlessness at About.com. In some patients, the death phenomenon invokes inner peace and helps them accept death.
Nevertheless, there are cases in which the dying patients experience extreme agitation and strange hallucinations like bugs crawling, etc.
Thus, due to the disturbing behavior of the patient, terminal restlessness is distressing for the dying individual as well as the family and caregivers.
All in all, it is associated with physical, psychosocial, and spiritual distress but does not include impaired consciousness.
When caring for and attending a person approaching death, keep in mind that though the patient may not respond to your talks and actions, still he/she can hear you.
Besides, you may read more about terminal restlessness at www.hknet.org .
Plus, at endlink.lurie.northwestern.edu , you can find detailed information on physiological changes and symptom management during the dying process.
After losing a loved one you may consider reading some inspirational book to help you cope with the loss.