Breathing changes when someone is dying can be frightening to see or hear. You may worry that the person is struggling, in pain or that you should be doing something to help.

Changes in breathing are common in the last days and hours of life and are often part of the body naturally slowing down. If the person seems distressed or uncomfortable, or you’re worried, ask a healthcare professional for help.

What breathing changes happen before someone dies?

Every person is different, and not everyone will experience the same changes. You may notice that their breathing

• becomes faster, slower or more shallow

• has long pauses between breaths

• changes between deeper breaths and quieter breaths

• sounds wet, rattly or noisy

• seems to come more from the tummy than the chest

Breathing may stop for several seconds and then begin again. This can be very upsetting to witness, but it can happen when someone is close to death.

Why does breathing change when someone is dying?

As the body slows down, it needs less oxygen and has less energy. The person may become sleepier or unconscious, which can change the rhythm of their breathing.

They may be less able to cough, swallow or clear saliva and mucus from the back of their throat. This can make their breathing sound noisy or rattly.

What is Cheyne-Stokes breathing?

Cheyne-Stokes breathing is an irregular breathing pattern that can happen near the end of a person’s life. Breaths may become deeper or faster, then slower or shallower, followed by a pause before breathing begins again.

It can look alarming, but it is often part of the body gradually slowing down. It isn’t possible to tell exactly how long someone has left from their breathing pattern alone.

What is the ‘death rattle’?

Some people use the phrase ‘death rattle’ to describe noisy breathing near death, although many people find the words upsetting. The sound happens when saliva or mucus collects at the back of the throat because the person can no longer cough or swallow it away.

The noise can be distressing for family and friends, but it doesn’t usually mean the person is in pain or suffering. They may be deeply asleep or unconscious and completely unaware of the sound.

What can I do to help?

You’re not expected to manage breathing changes on your own. Tell the care team about any changes and ask whether adjusting the person’s position, mouth care or medication may help. You can sit with the person, speak gently and keep the room calm. If they usually find touch comforting, you might hold their hand.

Don’t try to give food or drink if the dying person is too sleepy to swallow, as this may make them uncomfortable.

When should I ask for help?

Ask for help if the person seems frightened, is working hard to breathe, looks uncomfortable or you are unsure about what you are seeing. If they are at home, use the contact number provided by their GP, district nurse, hospice or palliative care team. If you don’t know who to call, ask the care team in advance.

It’s okay to ask someone to explain what’s happening more than once. You do not have to fix the changes yourself. Being there, noticing what is happening and asking for help when you’re worried are all meaningful ways to care.