Are they suffering when breathing becomes noisy, irregular or stops for periods?
Noisy or irregular breathing near death can be very upsetting to hear, but it does not always mean the person is suffering.
Noisy or irregular breathing near death can be very upsetting to hear, but it does not always mean the person is suffering. A dying person may be deeply asleep or unconscious. They may not be aware of the rattling sound or the pauses in breathing.
Still, breathlessness can be distressing for some people, especially if they look frightened, tense or panicked. Ask the palliative care team, GP, nurse or aged care staff to assess the person if you are worried.
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.
Why breathing changes near death
As the body shuts down, the person becomes weaker. Their brain, lungs and muscles do not control breathing in the same steady way. Breathing may become fast, slow, shallow, deep, uneven or stop for short or long pauses.
A pattern sometimes called Cheyne-Stokes breathing can happen. This means deeper or faster breaths are followed by shallow breathing or a pause, then breathing starts again. The pause can look alarming. It can last several seconds and sometimes longer.
Noisy breathing, sometimes called a "death rattle", happens when saliva or fluid pools in the throat or upper airways. The person may be too weak or sleepy to swallow or cough it away. Air moving through the fluid makes a rattling, gurgling or wet sound.
What may help
Do not try to force the person to cough. Do not put food, drink or tablets into their mouth if they are too sleepy to swallow safely.
Ask the nurse or care team what position is safest. Sometimes turning the person slightly on their side, raising the head of the bed, or changing pillows can reduce the sound or help breathing feel easier. A fan or open window may help if the person seems breathless and is aware enough to feel the air.
Mouth care is still important. A dry mouth can be uncomfortable, and medicines used to dry secretions can make the mouth drier. Ask staff how to moisten the mouth and lips safely.
Medicines may be used in some situations. Medicines for breathlessness, pain, anxiety or noisy secretions should follow the person's own plan. Do not start, stop or change doses without advice from the treating team.
When the noise is harder for family than for the person
Families often find noisy breathing harder to bear than the dying person does. This does not mean your reaction is wrong. The sound can make it feel as if the person is choking, even when they are not showing signs of distress.
Ask the team to explain what they are seeing. A useful question is: "Do they look distressed to you, or is the sound more distressing for us?" The answer can guide what happens next. Sometimes the best care is calm presence, mouth care and positioning. Sometimes medicine or a change in the plan is needed.
Signs that breathing may be distressing
Ask for review if the person has:
- a frightened facial expression
- gasping with panic or agitation
- tense shoulders, clenched hands or pulling at bedding
- moaning or calling out with breathing
- blue lips with distress
- breathing distress that is new or much worse
- symptoms that do not settle with the current care plan.
The team may check for pain, anxiety, fluid overload, infection, airway secretions, medicine effects or other treatable causes.
When to get help now
Contact the palliative care team, GP, nurse or aged care staff urgently if breathing looks distressing, the person is choking, lips or face turn blue with distress, there is sudden severe breathlessness, or you do not know what the care plan says.
Call 000 if this is a sudden life-threatening breathing problem in someone who is not expected to be dying, or if you have no end-of-life plan and need emergency help. If the person is expected to die and has a plan for changed breathing, follow the plan and call the listed service for support.
You may also want to read
- Is what I'm seeing normal dying, or are they suffering?
- Is this person dying now, and what should I do?
- How can I tell if someone is dying?
- Would IV fluids help someone who is dying?