It’s not uncommon to have dreams of death when you still have plenty of life left, but a new study reveals what you’ll actually dream about at death’s door.

Researchers from Azienda USL-IRCCS di Reggio Emilia in Italy surveyed 239 palliative care professionals—nurses, hospice volunteers, psychologists, and doctors—about the dreams and visions their terminally ill patients had described to them. Published in the journal Death Studies, the findings point to a striking collection of recurring images and themes in the final days of life, which researchers refer to as end-of-life dreams and visions, or ELDVs.

The most frequently reported experiences involved reunions with people who had already died. Deceased family members, friends, sometimes pets, appearing in dreams so vivid that patients described them as feeling completely real. One woman dreamed her late husband appeared and told her, “I’m waiting for you.” Another described climbing barefoot toward a glowing open door. A third recalled a white horse galloping along a shoreline. Researchers believe these experiences function as a form of psychological relief, a way for the dying to process what’s coming through imagery rather than words.

“ELDVs carry an important relational potential,” the research team wrote. “Talking about ELDVs allows patients to approach otherwise unspeakable topics through a symbolic mode of expression, bypassing the obstacles of rational language, which can instead trigger defensive reactions such as denial.”

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Not every vision was peaceful. Some patients reported deeply disturbing images, including one who described a monster wearing their mother’s face. Researchers believe experiences like that reflect unresolved fear and conflict, and may point to unmet emotional or clinical needs. The content of the dreams, whether comforting or terrifying, appears to carry real diagnostic weight for care teams paying close attention.

Study lead Elisa Rabitti noted that despite how common ELDVs are, patients frequently keep them to themselves. “Patients often hesitate to disclose them due to fear of ridicule, judgment, or being perceived as confused,” she said, which means a significant number of these experiences go undocumented.

This is also the first study to focus specifically on the sleep visions of the terminally ill, as opposed to near-death experiences in people who survived. The overlap is considerable. Tunnels, bright lights, staircases, deceased loved ones. The imagery repeats itself across both groups, regardless of the outcome.

What it all means is still unclear. But the consistency across patients, cultures, and circumstances is difficult to write off.