DOI: 10.14704/nq.2014.12.4.781

A REM Intrusion Model for Death Bed Visions: A Palliative Nursing Perspective

Hemei Zhang, Jiannong Zhao, Chenyu Xu, Pengcheng Wang, Zengna Xing, Cuilian Wang


Nurses often face the end of life conditions in resulting from several etiologies. It may be the end of life situations in chronic debilitating conditions like renal failures, oncological conditions and even progressive old age as such. Often around the clock nursing remains the primary mode of care for such patients. End of life care is complicated by several psychological and physical conditions. One of these psychological conditions which remain poorly understood is the presence of unusual end of life experiences where the exact role of nurses becomes controversial. In this article, we present a review of present literature on the end of life experiences. We will introduce by highlighting the importance of nursing position in observing these experiences. Subsequently, we will touch the neurobiological and psychological theories of near death experiences. We will then move towards the similarities between near death experiences and end of life dreams and visions. We will then elaborate on the REM intrusion model for near death experiences (NDEs). Finally, we will propound a REM intrusion model for end of life dreams and visions (ELDVs) and will see that the conditions of End of life predispose the patients for developing REM intrusions. Additionally, this model explains many of the features of ELDVs in both the phenomenological and neurological contexts.


near death experineces; REM; death bed visions

Full Text:

Full Text PDF


Agostoni E, Chinnock JE, Daly MDB, Murray JG. Functional and histological studies of the vagus nerve and its branches to the heart, lungs and abdominal viscera in the cat. J Physiol 1957; 135:182–205.

Alderson HL, Brown VJ, Latimer MP, Brasted PJ, Robertson AH, Winn P. The effect of excitotoxic lesions of the pedunculopontine tegmental nucleus on performance of a progressive ratio schedule of reinforcement. Neuroscience 2002; 112:417–425.

Barbato M, Bluden C, Reid K, Irwin H and Rodriguez P. Parapyschological phenomena near the time of death. J Palliat Care 1999; 15: 30–3.

Barrett D. Trauma and Dreams. Cambridge, MA: Harvard University Press, 1996.

Betty LS. Are they hallucinations or are they real? The spirituality of deathbed and near-death visions. Omega J Death Dying 2006; 53(1-2):37-49.

Blanke O, Ortigue S, Landis T, Seeck M. Neuropsychology: stimulating illusory own-body perceptions. Nature 2002; 419:269–270.

Bodineau L, Larnicol N. Brainstem and hypothalamic areas activated by tissue hypoxia: Fos-like immunoreactivity induced by carbon monoxide inhalation in the rat. Neuroscience 2001; 108:643–653.

Brayne S, Farnham C, Fenwick P. Deathbed phenomena and its effect on a palliative care team. Am J Hosp Palliat Care 2006; 2: 17–24.

Broughton R, Dunham W, Newman J, Lutley K, Dushesne P, Rivers M. Ambulatory 24 hour sleep-wake monitoring in narcolepsy-cataplexy compared to matched control. Electroenceph Clin Neurophysiol 1988; 70:473–48.

Calvo JM, Fernandez-Guardiola A. Phasic activity of the basolateral amygdala, cingulate gyrus, and hippocampus during REM sleep in the cat. Sleep 1984; 7:202–210.

Devinsky O, Feldmann E, Burrowes K, Bromfield E. Autoscopic phenomena with seizures. Arch Neurol 1989; 46:1080–1088.

Dugovic C, Shelton JE, Yun S, Bonaventure P, Shireman BT, Lovenberg TW. Orexin-1 receptor blockade dysregulates REM sleep in the presence of orexin-2 receptor antagonism. Front Neurosci 2014; 14; 8:28.

Ethier AM. Continuing education credit article: death-related sensory experiences. J Pediatr Oncol Nurs 2005; 22(2):104-111.

Fenwick P, Brayne S. End-of-life experiences: reaching out for compassion, communication, and connection-meaning of deathbed visions and coincidences. Am J Hosp Palliat Med 2011 2011; 28(1):7-15.

Fernandez-Guardiola A, Martinez A, Valdes-Cruz A, Magdaleno-Madrigal VM, Martinez D, Fernandez-Mas R. Vagus nerve prolonged stimulation in cats: effects on epileptogenesis (amygdala electrical kindling): behavioral and electrographic changes. Epilepsia 1999; 40:822–829.

Greyson B. Dissociation in people who have near-death experiences: out of their bodies or out of their minds? Lancet 2000; 355:460–463.

Hishikawa Y, Wakamatsu H, Furuya E, Sugita Y, Masaoka S, Kaneda H, et al. Sleep satiation in narcoleptic patients. Electroencephalogr Clin Neurophysiol 1976; 41:1–18.

Hugel H, Ellershaw JE, Cook L, Skinner J, Irvine C. The prevalence, key causes and management of insomnia in palliative care patients. J Pain Symptom Manage 2004; 27(4):316-21.

Jasper HH, Rasmussen T. Studies of clinical and electrical responses to deep temporal stimulation in man with some considerations of functional anatomy. Res Publ Assoc Res Nerv Ment Dis 1956; 36:316–334.

LaBerge S, Levitan L, Brylowski A, Dement W. “Out-of-body” experiences occurring in REM sleep. Sleep Res 1988; 17:115.

Lambert EH, Wood EH. The problem of blackout and unconsciousness in aviators. Med Clinic North Am 1946; 30:833–844.

Lawrence M, Repede E. The incidence of deathbed communications and their impact on the dying process. Am J Hosp Palliat Med 2013; 30(7):632-639.

Lempert T, Bauer M, Schmidt D. Syncope and near-death experience. Lancet 1994; 344:829–830.

Lempert T, Bauer M, Schmidt D. Syncope: a videometric analysis of 56 episodes of transient cerebral hypoxia. Ann Neurol 1994; 36:233–237.

Mahowald MW, Schenck CH. Dissociated states of wakefulness and sleep. Neurology 1992; 42:44–51.

Maquet P, Peters J, Aerts J et al. Functional neuroanatomy of human rapid-eye-movement sleep and dreaming. Nature 1996; 383:163–166.

Mazzarino-Willett A. Deathbed phenomena: its role in peaceful death and terminal restlessness. Am J Hosp Palliat Med 2010; 27(2):127-133.

McCarley RW, Benoit O, Barrionuevo G. Lateral geniculate nucleus unitary discharge in sleep and waking: state- and rate-specific aspects. J Neurophysiol 1983; 50:798–818

Montplaisir J, Billard M, Takahashi S, Bell IR, Guilleminault C, Dement WC. Twenty-four-hour recording in REM-narcoleptics with special reference to nocturnal sleep disruption. Biol Psych 1978; 13(1):78–89.

Morse M, Castillo P, Venecia D, Milstein J, Tyler DC. Childhood near-death experiences. Am J Dis Child 1986; 140: 1110–1114.

Muthumana SP, Kumari M, Kellehear A, Kumar S, Moose F. Deathbed vision is from India: a study of family observations in Northern Kerala. Omega J Death Dying 2010; 62(2): 97-109.

Nielsen TA. Mentation during sleep: The NREM/REM distinction. In: Lydic R, Baghdoyan HA, eds. Handbook of behavioral state control: Molecular and cellular mechanisms. Boca Raton, FL: CRC Press, 1999; 101-128.

Nofzinger EA, Mintun MA, Wiseman M, Kupfer DJ, Moore RY. Forebrain activation in REM sleep: an FDG PET study. Brain Res 1997; 770:192–201.

Noyes R Jr, Hoenk PR, Kuperman S, Slymen DJ. Depersonalization in accident victims and psychiatric patients. J Nerv Ment Dis 1977; 164: 401–407.

Noyes R Jr, Kletti R. Depersonalization in the face of life-threatening danger: a description. Psychiatry 1976; 39:19–27.

Oakman SA, Faris PL, Kerr PE, Cozzari C, Hartman BK. Distribution of pontomesencephalic cholinergic neurons projecting to substantia nigra differs significantly from those projecting to ventral tegmental area. J Neurosci 1995; 15:5859–5869.

Ohayon MM. Prevalence of hallucinations and their pathological associations in the general population. Psychiatry Res 2000; 97:153–164.

Olmstead MC, Munn EM, Franklin KB, Wise RA. Effects of pedunculopontine tegmental nucleus lesions on responding for intravenous heroin under different schedules of reinforcement. J Neurosci 1998; 18:5035–5044

Overeem S, Mignot E, van Dijk JG, Lammers GJ. Narcolepsy: clinical features, new pathophysiologic insights, and future perspectives. J Clin Neurophysiol 2001; 18:78–105.

Plowey ED, Kramer JM, Beatty JA, Waldrop TG. In vivo electrophysiological responses of pedunculopontine neurons to static muscle contraction. Am J Physiol Regul Integr Comp Physiol 2002; 283:R1008-1019.

Puizillout JJ, Foutz AS. Characteristics of the experimental reflex sleep induced by vago-aortic nerve stimulation. Electroencephalogr Clin Neurophysiol 1977; 42:552–563.

Sabom MB. Recollections of death: a medical investigation. New York: Harper & Row, 1982.

Saito H, Sakai K, Jouvet M. Discharge patterns of the nucleus parabrachialis lateralis neurons of the cat during sleep and waking. Brain Res 1977; 134:59–72.

Valdes-Cruz A, Magdaleno-Madrigal VM, Martinez-Vargas D, et al. Chronic stimulation of the cat vagus nerve: effect on sleep and behavior. Prog Neuropsychopharmacol Biol Psychiatry 2002; 26:113–118.

Vena C, Parker K, Allen R, et al.: Sleep-wake disturbances and quality of life in patients with advanced lung cancer. Oncol Nurs Forum 2006; 33:761-769.

Yeomans JS, Mathur A, Tampakeras M. Rewarding brain stimulation: role of tegmental cholinergic neurons that activate dopamine neurons. Behav Neurosci 1993; 107:1077–1087.

Supporting Agencies

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

| NeuroScience + QuantumPhysics> NeuroQuantology :: Copyright 2001-2019