From Close

Determining levels of consciousness – part 2

These notes of guidance are to help you recognise that your loved one is becoming drowsier, is in a deep sleep or has lapsed into unconsciousness. This will help you to maintain their dignity and comfort, and understand better the changes in alertness that people go through in the last few days and weeks of life. This guide is in two parts so you may want to start with part one before you continue here.

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How to identify the different levels of consciousness in your loved one

We have talked about the three typical levels of consciousness. Initially, you may have noticed that your loved one is drowsy but when you gently touch or speak to them, they wake up and are able to answer you with words or gestures.

At the next level, they may be in a deep sleep from which it is more difficult for them to wake up. They may open their eyes to your voice or touch, but it may take them longer to answer and acknowledge you and they will fall asleep again quickly. Finally, at the third level, you will find that they don’t respond at all when you attempt to wake them by gentle touch and words. Becoming unresponsive or unconscious is normal when your loved one is approaching death.

Even though your loved one is unable to respond to you it is important that you keep talking to them and explain whatever you are going to do. We do not know how much people can hear or understand at this stage in their lives, but we can see that people appear to gain comfort from hearing familiar voices around them. Try to talk to them as you would normally, if they were more alert.

There are other changes you may notice when your loved one is unconscious. It is not uncommon for them to sound “chesty”. This is because naturally occurring secretions pool at the back of the throat and your loved one is no longer able to clear these. You may find that the secretions appear less if they are in a more upright position supported by pillows. This symptom causes your loved one no distress, but medications, if required, can help control this. You can continue to cuddle, touch and sleep alongside your loved one if you wish and this is part of the valuable care you can provide for them.

When is my loved one likely to become unconscious?

As your loved one becomes less responsive you will notice several changes. They will no longer be able to swallow food, fluid or tablets; they will not be able to use a commode or toilet and will have a pad in place to manage their bowel movements and urinary output. It is not uncommon for there to be very little urine or bowel movements. You may also notice changes in skin colour and their breathing pattern will change.

Your loved one will become sleepier and this will progress as we have discussed until finally, they are no longer responsive or conscious. When and how these changes occur will vary between individuals. These changes may occur over a period of hours or a few days, sometimes it may be a week or so. If you are staying at Cottage Hospice, the team will be able to advise and support you, so please ask because we are all here to help you.