Identifying Breathing Changes in Hospice

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Introduction

Changes in the breathing pattern often begin to happen when the person is sleeping. When they are more awake and alert, their breathing will seem better again. These changes progress toward the end of life and these breathing changes often cause caregivers to feel anxious and alarmed. However, this type of breathing is normal at the end of life and does not mean the person is suffering.

Signs

  • Shallow, irregular breathing (8 or fewer breaths per minute).
  • Periods of no breathing (apnea) with 5 to 30 seconds or longer between breaths.
  • Panting type breaths (breathing rate above 25 breaths per minute).

The pattern of breathing can vary. You may notice periods when there are long pauses between breaths. These pauses are called apnea and may last for longer periods of time as the dying process progresses. Breathing can also become heavy and deeper or very shallow and rapid.

 

  • Noisy, rattling or gurgling sounds breathing.

This occurs when a person no longer has the normal reflex to “clear their throat” or swallow. Saliva and nasal secretions pool in the back of the throat and as the person breathes through their mouth a “rattling” sound occurs. This can be uncomfortable for us to hear, but this sound does not mean that the person is choking or “drowning.” When this change happens, the dying person is usually not conscious and does not seem to be aware of or be uncomfortable because of this symptom. If you feel your loved one is not comfortable, please alert your hospice nurse and she or he will work with you to manage this symptom.

 

  • Silent, very shallow movements of the mouth without taking in any air

If this happens it would indicate that the person is very close to death. Sometimes the last breaths may be deep and sighing.

Remedies

  • Elevate the head of the bed.
  • Position the person on their side to help clear any secretions that are causing noisy breathing.
  • Avoid suctioning. It may help reduce the distressing sound for a little while, but does not relieve the cause of the symptom and can increase irritation that adds to congestion. The suctioning procedure itself may cause discomfort to the dying person.
  • Use a dampened cloth or gauze wrapped around your fingers, to gently clear the inside and outside of the mouth of the sticky secretions that can accumulate. You can also use a moist sponge swab.
  • Ask your care team for their suggestions. Medication may help dry up the moisture that causes noisy breathing but can leave other areas like the mouth, nose, and eyes dry as well.

These breathing changes signal that this is the time to focus on things that will bring comfort and peace. Play soft music, gently touch the person and reassure them that you are close by. Your hospice team is available to answer your questions, provide comforting care and support during this time.

 

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