As a person nears the end of life, their body undergoes many changes, including shifts in how they breathe. The respiratory rate, the number of breaths taken per minute, often alters significantly. These changes are a natural part of the body’s process of shutting down. Understanding these alterations can help provide comfort and clarity during a challenging time.
Understanding Changes in Breathing Near Death
A healthy adult at rest typically takes between 12 to 20 breaths per minute. As an individual approaches the end of life, their breathing patterns often deviate from this regular rhythm. The respiratory rate can become shallower and more irregular, shifting from steady, predictable breathing to more erratic patterns.
Respiratory changes include fluctuations between periods of rapid and slow breathing. Breathing may also become less deep, reflecting the body’s diminishing energy levels and the gradual slowing of various organ systems. These changes are a common part of the dying process, signaling the body’s transition.
Recognizing Specific Breathing Patterns
These general changes often manifest as distinct patterns. One frequently observed pattern is Cheyne-Stokes respiration, characterized by a cycle of progressively deeper and faster breaths, followed by a gradual decrease in effort. This crescendo-decrscendo pattern culminates in a temporary pause in breathing, known as apnea, which can last from 5 to 30 seconds. The cycle typically repeats every 30 seconds to 2 minutes. While alarming to family members, this pattern is usually not distressing for the individual.
Another pattern is agonal breathing, also described as gasping. This involves isolated, noisy, and deep gasps that occur when the brainstem receives insufficient oxygen. These gasps are involuntary reflexes and do not indicate conscious suffering. Agonal breaths are not effective and can sound like snorting, gurgling, or moaning, often occurring minutes after the heart has stopped.
The “death rattle” is another common phenomenon, though not a breathing pattern itself. This sound is caused by the accumulation of saliva and bronchial secretions in the throat and upper airways. As a person weakens and loses the ability to swallow or cough, these fluids collect, creating a wet, gurgling, or rattling sound with each breath. While unsettling for those nearby, the dying person is unaware of the sound and does not experience discomfort.
The Physiological Reasons for Altered Breathing
The changes in breathing patterns near death are rooted in several biological mechanisms. A primary factor is the decreased function of the brain’s respiratory control center. As the body weakens, blood flow and oxygen supply to the brain diminish, making the brainstem less responsive in regulating consistent breathing. This leads to the irregular and fluctuating respiratory rates observed.
Metabolic changes also play a role, as failing organs, such as the kidneys and liver, lead to an accumulation of waste products like carbon dioxide in the bloodstream. These chemical imbalances alter the blood’s chemistry, affecting the body’s respiratory drive and contributing to erratic breathing patterns. Additionally, weakened muscles throughout the body, including those involved in breathing and swallowing, contribute to the inability to maintain consistent breathing effort or clear airways.
Supporting Comfort During Breathing Changes
Providing comfort to someone experiencing these breathing changes involves several practical approaches. Adjusting the person’s position can help manage secretions and improve comfort. Turning the person gently onto their side or elevating their head can allow gravity to assist in draining fluids, potentially reducing noisy breathing.
Maintaining good mouth care is also important, as a dry mouth can cause discomfort. Regularly moistening the lips and mouth with a damp cloth or sponge can provide relief. Medications, when prescribed, can help alleviate restlessness or anxiety that may accompany the dying process.
It is important to note that oxygen therapy is generally not beneficial for breathing patterns like Cheyne-Stokes and may even cause agitation in some cases. For caregivers, understanding that these breathing changes are a natural part of the dying process can reduce distress. Focusing on providing a calm presence and emotional support is paramount during this time.