Our dreams become more emotive and symbolic as we approach death

People in palliative care who are approaching death often have vivid dreams featuring deceased loved ones and symbols of transition. The doctors and medical professionals who look after them say these dreams often bring patients comfort and make them less scared of dying.

These dreams “offer psychological relief and meaning to people facing end of life,” writes Elisa Rabitti at the Palliative Care Local Network in Reggio Emilia, Italy.

Rabitti led a team that surveyed 239 local palliative care doctors, nurses, psychologists and other health professionals about dreams recounted to them by terminally ill patients.

The most common dreams and visions, which occurred while people were awake, involved encounters with deceased family members or pets. One woman, for example, had a dream about her late husband, in which he told her, “I’m waiting for you.” These dreams provided a sense of inner peace and helped people to accept death, write Rabitti and her colleagues.

Others dreamed of doors, stairways or light, with one describing a dream about climbing barefoot towards an open door filled with white light. This may be a coping mechanism to explore and make sense of their impending passage from life to death, the study authors write.

Most commonly, the people felt “peaceful” and “comforted” in relation to these end-of-life dreams and visions. Only a small proportion of them – about 10 per cent – were distressing, including one in which one person saw a monster with her mother’s face dragging her down.

Christopher Kerr at Hospice Buffalo in New York state has also conducted research showing that dreams about deceased loved ones are very common in the terminally ill, and become more frequent as death approaches. “What’s really interesting is it’s not random who comes to you – it’s always those people who loved and secured you,” he says. His research has also found that dreams about “preparing to go” are common. For example, “patients often describe dreams about packing or getting on a bus,” he says.

End-of-life dreams and visions can “put people back together”, says Kerr. For instance, he once saw a 70-year-old woman, a mother of four adult children, move her arms as if cradling a baby while having visions of her first child, who died stillborn. She had found his loss too difficult to talk about, but his metaphysical return at the end brought her comfort. “We’ve also had lots of veterans, and whatever wounds or burdens they’re carrying are often addressed in their end-of-life dreams,” says Kerr.

The frequency of these dreams and visions ramps up as death approaches because “dying is progressive sleep”, believes Kerr. “[The people are] in and out of sleep, which seems to make their dreams more vivid and striking – often they say it’s not a dream; it feels real.”

We often assume that the end of life is a sad and terrifying experience because “built into our survival is a visceral response to threat”, says Kerr. But the final weeks of a terminal illness can be rich in love and meaning, and patients “inevitably come to something of acceptance”, he says. “One of the most striking things is the absence of fear.”