Drowsiness vs Lethargy vs Obtunded

Published on April 15, 2023

Updated on November 18, 2023

As a hospice registered nurse case manager, you will encounter patients who experience various degrees of altered consciousness. It is essential to understand the difference between , , and obtundation, as they can indicate different underlying medical conditions and require different interventions. For example, is common and often expected, but and obtundation are more profound which may mean the patient is closer to death than further way.

Understanding the Differences – Drowsy, Lethargic, Obtunded


Drowsiness refers to a state of decreased alertness and increased desire for sleep. Patients who are drowsy may feel tired, sleepy, and sluggish but are still responsive to stimuli. They may appear to be dozing off, but they can be easily awakened and can maintain a conversation. Drowsiness is a common symptom in patients receiving , especially those who are on medications that cause sedation, such as opioids or benzodiazepines. One way to test to see if a patient is experiencing drowsiness is to simply ask the patient if they are tired, and just want to sleep; the answer is typically “yes” to both questions.


Lethargy refers to a state of extreme tiredness, sluggishness, and decreased activity. Patients who are lethargic may appear drowsy but are more difficult to awaken and may require repeated stimulation to maintain consciousness. They may only respond to loud noises or physical stimuli, and their responses may be delayed or limited. Lethargy can be a sign of more severe underlying medical conditions, such as , metabolic disturbances, or end-stage organ failure. Most of the time lethargy presents itself as someone who wants to participate within the environment for which they are located including the people around them as evidenced by their trying to talk or move or otherwise interact where in the process they fall back asleep or appear to be drowsy after trying. In my experience, the drowsy person wants to sleep, and the lethargic person wants to wake up. Please keep in mind that as I share this, we are talking about terminally ill hospice patients.


Obtundation refers to a state of decreased alertness, responsiveness, and interest in the environment. Patients who are may appear drowsy or lethargic, but their responses to stimuli are further decreased. They may only respond to painful stimuli and may require more aggressive stimulation to maintain consciousness. Obtundation can be a sign of a more severe underlying medical condition, such as severe brain injury, advanced dementia, or end-stage cancer. In my experience, the hospice patient is not trying to wake up, and at times you may just get their eyes open.

As a , it is important to assess patients regularly for changes in their level of consciousness and to document these changes accurately. If a patient's level of consciousness changes suddenly or significantly, it is important to notify the healthcare provider immediately. In addition, it is essential to determine the underlying cause of altered consciousness and to provide appropriate interventions, such as adjusting medication doses, addressing pain or , or providing comfort measures.

Hospice Considerations

If a patient is consistently drowsy, then explroation should take place to see if they are comfortable in that state; and if not, then address the issue if possible. If the patient is lethargic or obtundened, then investigation needs to take place as to whether this is due to reversable causes such as infection or irreversible such as the patient is starting or otherwise within the transitioning phase of the dying process and the end of life.


Understanding the difference between drowsiness, lethargy, and obtundation is essential for hospice nurses to provide high-quality, patient-centered care to patients at the end of life. Regular assessment, accurate documentation, and timely intervention are critical in managing these symptoms and improving patients' quality of life.


The Difference Between Lethargy, Obtundation, Stupor, and Coma

The Importance of Caregiver Journaling

Reporting Changes of Condition to Hospice

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