Terminal restlessness can appear in the final days or hours as agitation, pacing, moaning, or sudden confusion. You want to keep your loved one safe, calm, and comfortable, and you need clear steps you can use right now. 

This guide explains practical ways to ease terminal restlessness, what to avoid, and when to call your hospice nurse for extra help.

What Terminal Restlessness Looks Like

Terminal restlessness is a cluster of symptoms that may include anxiety, fidgeting, pulling at clothing or lines, picking at the air or bedding, calling out, sleeplessness, or a sudden desire to get up even when weak. The cause is often a mix of physical discomfort, changing brain chemistry, unmet needs, and the natural closing of the body’s systems. 

Quick tip: If nighttime restlessness is keeping your family up, our hospice nurses can help you build a simple sleep plan and adjust comfort measures. Read this full guide here. 

Your job is not to fix every cause. Your job is to reduce triggers, meet basic needs, and create a calm environment so your loved one can settle.

A Simple 3-Part Plan You Can Start Tonight

1) Soften the Environment

A quiet, predictable space lowers stimulation that can fuel restlessness.

• Dim lights. Use a single lamp or nightlight. Avoid bright overhead lighting.
• Lower noise. Turn off nonessential TVs and devices. Play soft, familiar music at a low volume.
• Reduce crowding. One or two calm visitors at a time works best.
• Keep the room cool and comfortable. A small fan can help with airflow.
• Offer reassuring presence. Sit where they can see you. Speak slowly and gently.

Tip: Choose one scent only. A drop of lavender on a cotton ball near the bed can be soothing for some. Skip strong or mixed fragrances.

2) Remove Common Triggers

Small discomforts can drive big agitation.

• Pain: Ask, “Are you hurting?” Watch for furrowed brows, clenched teeth, or guarding.
• Full bladder or bowels: Check for constipation. Ask your nurse about a simple bowel regimen.
• Thirst or dry mouth: Offer ice chips or swabs if safe. Moisturize lips.
• Position: Reposition with pillows every 2 hours or as tolerated. Float heels. Protect bony areas.
• Temperature: Add a light blanket if cool. Remove layers if warm.
• Lines and clothing: Secure tubing. Use soft, loose garments.
• Delirium triggers: Remove glare, reduce clutter, and add a clock and family photos for orientation.

3) Use Gentle, Grounding Techniques

Human connection can do more than gadgets or gadgets ever could.

• Hand-over-hand calming: Place your warm hand lightly on their forearm or shoulder. Breathe slowly so your pace guides theirs.
• Short, simple phrases: “I am here. You are safe. We will get through this together.”
• Guided breathing: Inhale together through the nose for 3 counts. Exhale through the mouth for 4 counts. Repeat 5 times.
• Familiar rhythms: Read a favorite poem, prayer, or story in a soft voice.
• Sensory focus: Offer a soft washcloth warmed with water to the forehead. Try gentle lotion on your hands and feet.
• Music memories: Play one favorite song. Stop if agitation increases.

Safety First: What To Do If They Try To Get Up

Restlessness can lead to sudden attempts to stand or walk.

• Stay close. Keep a hand on the gait belt or shoulder.
• Clear pathways. Remove rugs and cords. Place non-skid socks on feet.
• Lower the bed if possible. Keep the call bell or your phone within reach.
• Do not hold them down. Guide instead. Blocking movement can increase fear.
• Offer a purpose. “Let’s sit and have water first.” Give a folded towel to hold if they pick at bedding.
• If falls are a risk, stay within arm’s reach and call your hospice nurse about added support.

Medication Support: What Families Should Know

Your hospice team may recommend medications that ease anxiety, pain, or delirium. These may include options for short-term or scheduled use, based on your loved one’s symptoms and goals of care.

• Follow the plan on your medication sheet. Call if you are unsure about dosing.
• Use non-drug steps first when possible, then layer medications as instructed.
• Watch for side effects like sleepiness, shallow breathing, or worsened confusion. Report concerns to your nurse right away.
• If agitation is severe or does not respond, ask about a same-day visit or an adjustment to the plan.

For a clear, step-by-step overview of safe hospice meds at home, read our full guide: Hospice Medications 101: Safe, Comfort-Focused Care at Home in Georgia

A One-Page Night Plan You Can Post

Before Bed (10 minutes):

• Dim lights, lower TV volume, set room temperature, give mouth care, and complete bathroom needs.
• Reposition with pillows. Check skin. Offer a light blanket.
• Review medications due in the next 6 hours. Keep the list at the bedside.

If Restlessness Starts:

• Use short phrases. Breathe together. Try music or a soft cloth to forehead.
• Check for pain, toilet needs, dry mouth, or uncomfortable position.
• Reassess after 10 minutes. If not improved, follow the as-needed medication plan.

When To Call the Nurse Now:

• Agitation is getting worse or feels unsafe.
• New pain, shortness of breath, choking, or fever.
• You are worried. Your instincts matter.

What To Avoid

• Multiple people talking at once.
• Arguing or complex explanations.
• Forcing food or fluids if swallowing is unsafe.
• Strong lighting or flashing screens.
• Sudden temperature changes.
• New scents or multiple fragrances.

When Restlessness Signals Something More

Restlessness can be a natural part of dying, yet it can also signal an urgent issue.

Call your hospice nurse if you notice any of the following:

• Rapid breathing, gasping, or new shortness of breath
• Signs of severe pain that do not ease with the plan
• New chest pain, bleeding, or seizures
• Sudden confusion after a medication change
• Falls or near falls

If you are not on hospice and symptoms are severe, call your doctor or emergency services.

How Your Hospice Team Helps

Your team supports the whole person and the whole family. You should expect:

• Fast guidance on medication timing and non-drug techniques
• Equipment to support safety, such as hospital beds and fall mats
• Education on what to expect at different times of day
• Emotional and spiritual support for you and your loved one
• 24-hour help for urgent needs

If you need more support, ask about short-term respite care or, if symptoms are very difficult, an evaluation for continuous home care or inpatient support based on eligibility.

Frequently Asked Questions

• Is terminal restlessness the same as pain?
  Not always. Pain can drive agitation, but restlessness can also come from delirium, constipation, urinary retention, medication effects, or spiritual distress. Treat the likely causes and call your nurse for guidance.
• Should I wake them for medications?
  Follow the plan you have. If as-needed doses are ordered for restlessness or pain, it is better to give them early when signs first appear. Ask your nurse to clarify the best timing.
• How long does terminal restlessness last?
  It can be brief or come and go. Many families see episodes in the evening or overnight. Your team can adjust the plan if episodes keep returning.
• Can aromatherapy or herbal remedies help?
  Some families find lavender or chamomile soothing. Always check with your nurse before using any oils, teas, or supplements, since they can interact with medications or irritate the skin.

Talk to a Hospice Team Today

Our hospice team can help you personalize a night plan for terminal restlessness, review your medication instructions, and decide when to use as-needed doses. Call us at (470) 395-6567 or reach us online, to help youwith equipment needs such as a hospital bed, fall mats, or mouth care supplies, and coordinate with your physician so support arrives quickly.