Short answer: The death rattle is wet, rattling or gurgling breathing that can happen near the end of life when saliva and mucus collect in the throat and airways. The sound can be upsetting to hear, but it does not by itself mean that someone is in pain. A hospice nurse can assess their comfort and guide positioning, mouth care and, when appropriate, medication.
If you are hearing this sound now, call your loved one’s hospice team for guidance. You do not need to identify the breathing pattern on your own.
In this guide: What it sounds like · How long it lasts · What can help · When to call for help
What Does the Death Rattle Sound Like?
It may sound wet, bubbly or gurgling, or like a low rattle with each breath. The medical term is terminal respiratory secretions. A description or video can help you recognize the term, but cannot confirm what is happening to a particular person.
Watch: Hospice Nurse Julie explains terminal secretions
In this 59-second Short, Julie McFadden, RN, known as Hospice Nurse Julie, explains the sound and discusses positioning and medicines that reduce secretions.
This is general education. Your loved one’s hospice team should assess their comfort and show you which care measures are appropriate.
Watch the Short on YouTube · Read the comfort measures below
What causes the sound?
As swallowing and coughing weaken during the dying process, secretions can accumulate. Air passing through them creates the noise. It does not happen to everyone. The National Cancer Institute’s guide to the last days of life explains these changes and how the care team can help.
Video by Hospice Nurse Julie. Published October 16, 2024. Captions are available in the YouTube player.
Is the Death Rattle Painful?
Noisy secretions are generally unlikely to be painful or distressing to the person, according to Marie Curie’s guidance on chest secretions. However, the sound alone cannot tell you whether someone is comfortable. Tell the hospice nurse about new restlessness, signs of pain or effortful breathing so they can assess the person.
How Long Does the Death Rattle Last Before Death?
It often occurs in the last hours or days of life, but there is no reliable countdown. Some people die soon after it begins; others live longer. Ask the hospice nurse what the sound means alongside the other changes they are seeing. A quieter sound after care measures does not, by itself, show that the underlying illness has improved.
How Is It Different From Other Breathing Changes?
These terms describe different things. More than one change may happen at the same time.
| Change | What families may notice |
|---|---|
| Death rattle | Wet, gurgling or rattling sounds from pooled secretions. |
| Cheyne-Stokes breathing | A repeating pattern of deeper or faster breathing, then slower breaths and pauses. |
| Agonal breathing | Abnormal gasps. Sudden collapse with unresponsiveness and only gasping can signal cardiac arrest and requires emergency help. |
Marie Curie explains the different breathing changes near death. Our guides to altered breathing patterns and signs someone is actively dying give more context.
What Can Help With the Death Rattle?
Ask your hospice nurse to talk you through a comfort plan. Useful questions include: “Does my loved one look comfortable?” and “What should I do if the sound changes?”
Positioning
The nurse may recommend resting on one side or raising the head and chest. Ask them to demonstrate a safe position before moving your loved one. The best approach depends on the person’s condition and comfort.
Mouth care and fluids
Ask how to keep the mouth and lips moist. Do not force food or drinks when swallowing is difficult. If your loved one receives fluids or tube feeding, the care team can review whether adjustments would help; do not change these yourself. The National Cancer Institute discusses mouth care and eating and drinking in the final days.
Medicines for secretions
A hospice clinician may prescribe an anticholinergic medicine, such as glycopyrrolate, scopolamine or atropine, to reduce secretion production. These medicines do not reliably stop the sound and can have side effects, including dry mouth or confusion. Give them only as prescribed and call the team before changing a dose.
The Palliative Care Network of Wisconsin notes that evidence for these medicines is mixed. The aim is comfort, with realistic expectations about how much the noise may change.
Suctioning
Do not attempt deep suctioning. It can be uncomfortable. A clinician may sometimes use gentle suction for accessible secretions, but your hospice nurse should decide whether it is appropriate and provide any necessary instruction.
When Should You Call for Help?
For a person receiving hospice care: Call the hospice team when noisy breathing is new, the person seems uncomfortable, breathing looks more difficult, prescribed measures are not helping, or you are unsure what to do. Follow the person’s established care plan for expected end-of-life changes.
For sudden or unexpected collapse: If someone is unresponsive and is not breathing normally or is only gasping, call 911 and follow the dispatcher’s instructions. The American Heart Association identifies these as signs of cardiac arrest. Do not assume an unexplained breathing emergency is a death rattle.
Support for the Family
You can understand the sound and still find it difficult to hear. Ask the nurse to stay with you while explaining what they see, write down the number to call overnight, and take a break when another trusted person can be present.
If your loved one is receiving Suncrest hospice care, contact your care team directly with symptom concerns. If you are exploring support, contact Suncrest to learn about care options.
Related Suncrest video: Dr. Julie Marmon discusses “What is the Right Thing for the Patient?”
Frequently Asked Questions
Does everyone have a death rattle?
No. End-of-life changes vary. Its absence does not tell you that death is far away, and its presence cannot provide an exact timeline.
Can the death rattle stop before someone dies?
The noise can become less noticeable after positioning or other care. A change in the sound alone does not show how much time remains. Ask the nurse to explain the overall picture.
Is a death rattle the same as choking?
No. The term refers to noisy secretions near the end of life. Do not use that label to dismiss sudden trouble breathing. Call for help if you are unsure what you are hearing.
Can medication stop the sound completely?
Not always. Ask the hospice clinician what improvement to expect and when to call back if a prescribed medicine is not helping.
This article provides general education. Your hospice team can give guidance based on your loved one’s condition and care plan.
