Why are they sleepier after medication?
People can become sleepier after medicines used in palliative care.
People can become sleepier after medicines used in palliative care. Sometimes this is an expected short-term side effect. Sometimes it means the dose, medicine mix, illness or another medical problem needs review.
Sleepiness can also be part of dying. That makes it hard for families to know what is medicine and what is the illness. You do not have to work this out alone. Tell the palliative care team what has changed, when it started, and which medicines were given.
General information: This page gives general information for people in Australia. It cannot tell you exactly what is happening in one person's situation. If you have concerns about a symptom, medicine, treatment decision or change in someone's condition, contact their doctor, palliative care team, nurse or other treating health professional.
Medicines that can cause sleepiness
Several medicines used near the end of life can make a person drowsy. These include opioids such as morphine or oxycodone, medicines for anxiety or agitation such as midazolam or clonazepam, some nausea medicines, and some medicines for nerve pain.
Drowsiness may be more noticeable when a medicine is first started, after a dose increase, or when several sedating medicines are used together. Palliative Care Australia notes that drowsiness or confusion from opioids may happen for a short time after starting treatment or increasing the dose.
Other causes are common
Sleepiness is not always caused by medicine. A person may be sleepier because the illness is progressing, they are close to death, or their body is weaker.
Other possible causes include infection, dehydration, constipation, kidney or liver changes, high calcium, low oxygen, delirium, poor sleep, or a build-up of medicine because the body is clearing it more slowly.
The pattern matters. A person who is gradually sleeping more over days may be entering the last phase of life. A person who suddenly becomes very hard to wake after a new medicine or dose may need urgent review.
Is sleepiness always a bad sign?
Not always. If a person has been in severe pain, breathless or frightened, they may sleep once the symptom settles. This can look dramatic, especially if they had been awake because they were distressed.
The goal is usually comfort with as much alertness as the person wants and can manage. Some people would rather accept some sleepiness to have better pain relief. Others want the team to reduce sedation if possible so they can talk with family. These preferences should guide the plan where possible.
What to watch and record
Write down the time medicines were given, what symptom was being treated, and what changed afterwards. If the person has a caring@home diary or local medicine chart, use that.
Tell the team if you notice:
- the person is much harder to wake than before
- new confusion, agitation or hallucinations
- twitching, jerking or unusual restlessness
- breathing that is much slower than expected
- snoring or noisy breathing that is new and worrying
- pain, breathlessness or agitation despite sleepiness
These signs do not always mean the medicine is wrong, but they deserve clinical advice.
Do not skip medicines without advice
It can be tempting to stop pain or breathlessness medicine because the person is sleepy. This can leave them distressed when the medicine wears off. It may also cause withdrawal symptoms if an opioid has been taken regularly.
If you think a medicine is making the person too sleepy, call the palliative care team, GP, nurse or pharmacist. Ask whether the plan should change and what to do before the next dose.
When to get help now
Call the palliative care team or after-hours number urgently if sleepiness is sudden, severe, or comes with breathing trouble, new confusion, twitching, uncontrolled symptoms, or a possible medicine mistake.
Call 000 if the person cannot be woken, is not breathing, has blue lips, or you think they may have had an overdose. If the person is expected to die at home and has a written plan, use the plan and call the listed palliative care contact unless it is a life-threatening emergency.
You may also want to read
- Does morphine make someone die sooner?
- Why did the morphine dose suddenly increase?
- How do I know when to give breakthrough medicines at home?
- When should I seek urgent medical advice?