Signs Death Is Near in Hospice: Altered Breathing Patterns

End of life breathing refers to the noticeable changes in a person’s breathing patterns during the final stages of life. These changes occur as the body prepares to shut down. Families often recognize these shifts, and they can bring both understanding and concern. The changes can be dramatic, which is why knowledge helps families feel more prepared.

End of life breathing may involve breathing that becomes slow, quick, shallow, irregular, or even noisy. Each of these patterns has a specific meaning and place in the dying process. For loved ones, seeing or hearing these changes can be distressing. It helps to remember that these shifts are a natural part of the body’s progression.

Normal breathing is steady and even. In healthy adults, breaths usually range from 12 to 20 per minute. Each breath is smooth, consistent in depth, and without unusual pauses or sounds. At the end of life, this regular pattern changes as the body prepares for death.

Cheyne-Stokes respiration is a common breathing pattern before death. It includes periods of deep, rapid breathing that slowly become shallower, followed by complete pauses, or apneas. After several seconds, the cycle repeats. This breathing can be unsettling to watch but is not painful for the patient. It reflects how the brain’s control over breathing begins to waver.

Agonal breathing is marked by gasping or irregular breaths. These breaths can appear abrupt or spaced far apart, often superficial and sometimes accompanied by a slight movement of the jaw. Some describe this as mandibular or “fish out of water” breathing. This type of breathing typically signals that death is very near, often within minutes to hours.

Noisy breathing, often called the “death rattle” or terminal secretions, is caused by the build-up of saliva or mucus in the back of the throat. The person may be too weak to clear these secretions. As air moves through, it can create rattling or gurgling sounds. While the sound is striking, studies show it does not cause discomfort for the dying person.

Shallow breathing at end of life is common. Breaths become lighter, with less rise and fall in the chest. This is a sign that the body’s need for oxygen is dropping. Shallow breathing often alternates with episodes of pauses or apnea.

Labored breathing hospice teams witness includes visible effort in breathing. This may involve the chest or shoulders rising high, or the use of neck muscles with each breath. Labored breathing before death can be exhausting, but hospice teams focus on comfort. Medications, changing position, or emotional support can ease the sense of shortness of breath.

• Dim the lights.
• Play soft, soothing music.
• Offer comforting touches, such as holding hands.
• Surround your loved one with familiar items to provide reassurance.

• Elevate the head of the bed.
• Place pillows for support under the back and neck.
• Gently turn the person on their side if needed.
• Change positions regularly to drain secretions and ease breaths.

• Offer small sips of water if safe.
• Use a moist cloth or oral swabs to keep lips and mouth comfortable.
• Avoid forcing fluids, which can worsen breathing difficulties.

• Opioids like morphine or dilaudid can slow and ease breathing.
• Anticholinergic medications may help dry out excess secretions that cause noisy breathing.
• All medications are provided to reduce discomfort, not to hasten death.

• Gentle oxygen flow through a nasal cannula may relieve breathlessness.
• Non-invasive options like CPAP or BiPAP may sometimes be needed.
• Hospice teams adjust oxygen based on comfort, not to extend life.

• Speak calmly and offer emotional support.
• Share memories and loving words.
• Invite spiritual advisors, chaplains, or counselors if desired.
• Even if the patient is unresponsive, presence and connection can be deeply comforting.

Some people experience periods of confusion, restlessness, or agitation. It may be hard for them to recognize familiar faces or surroundings. These changes happen as brain activity slows.

Hands, feet, and legs might become cool to the touch. Skin can appear pale, blotchy, or bluish, especially on the extremities. These changes are due to decreased circulation.

As muscles weaken, control over bladder and bowels is lost. This is common and natural when the body is near death.

The heartbeat may become weak and irregular, and blood pressure often drops considerably. You may also notice shallow or faint pulses at the wrists, arms, or legs.

Moving, sitting up, or even adjusting position becomes challenging. Some people lose the strength to speak or swallow. Muscles may twitch or jerk due to chemical changes in the body.

These signs often occur gradually, sometimes over days or weeks. Suncrest Hospice staff guide families through each stage, offering comfort and answers as needed.

Coping with the changes that come at the end of life can feel overwhelming, but you do not have to face them alone. If you notice new breathing patterns—such as rapid breathing before death, labored breathing in hospice, or shallow breathing at end of life—our team at Suncrest Hospice is here to help. We guide families through these moments with kindness, expertise, and ongoing support.

If you have questions about hospice, want to discuss care options, or need immediate guidance, we encourage you to contact Suncrest Hospice today. Our compassionate professionals are ready to listen and provide the information you need.

Call [Insert Suncrest Hospice Phone Number] or Contact Us Online to speak with a member of our care team.

Your comfort, clarity, and peace of mind matter to us. Let Suncrest Hospice support you and your loved ones every step of the way.