Laboring To Leave ~ Difficult Breathing at End of Life

Dear Barbara, I would like to know why the breathing pattern is different at
end of life. My Mother had fast and labored respirations. She did have
COPD, but my Dad had the same breathing pattern and he did not die from
COPD. This was very disturbing to me. Are they suffering when breathing
like that?

The irregular, difficult breathing that occurs at end of life frightens most
people. As we watch we feel something bad is happening. Our loved one is
hurting, struggling, suffering, and of course this is disturbing to us.
In the hours to minutes, sometimes even days, before death, a person’s
breathing changes. First it becomes fast, often with congestion, and then
gradually the breaths becomes slower and slower. As breathing slows (ten
times, or even six times, a minute) the person actually breaths like a fish,
with their mouth opening and closing. This can be frightening if you don’t
know that it’s normal.
The congestion that occurs before death will depend upon how hydrated or
dehydrated a person is. The more fluids in their body, the more congestion.
Sometimes changing their position (laying them on their side) will help to
redistribute the fluid, and the breathing will sound quieter. Suctioning the
fluid generally does not eliminate it. The bottom line is that congestion and
difficult breathing are a part of the normal dying process.
Is the person suffering? I think not, although it appears that they are. By the
time they are hours from death their awareness of what is going on around
them and of their body has diminished. What I envision is the little chick
working hard to get out of its shell. In the hours before death from disease
our body is shutting down. It is laboring to release itself from this planet. It
is a struggle, just as the chick is struggling, but I don’t think either the
person or the chick are suffering.

Something more about Laboring to Leave:

Difficult breathing during the natural dying process is only one of the many changes that we will witness when a person is dying. It's comforting to know what to expect during that process. Gone From My Sight (The Little Blue Book) is a "road map" of what will occur during the dying process. The Eleventh Hour is the companion book and is more specific about the changes in the last days, hours, minutes, seconds and just after death. These two books, along with your nursing staff, will provide knowledge so that you can better support the one who is laboring to leave.

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P Haines

My husband’s breathing was heavy and fast for about 4hrs and then seem to slip to the upper abdomen for about 2hrs before passing, he had palliative care,,yes I feel the same guilt he had midazolam and glycopyrronium ..and never open his again.
BK Books replied:
It’s difficult to watch the labor to leave this world. Blessings to you. Barbara


My mother also had that very fast and loud breathing without any pauses. It was so stressful and hard to witness, and she was totally awake and alert for the whole time.
It continued for 9 hours, beginning around 7 pm and continued until she passed away at 4.45 am.
She passed two hours after been given the second shot of morphine and sedatives( named Stesolid in my country). It was too little time between the shots.
It was my fault, I panicked 30 min after the first one. I thought my mom’ breathing should have been slowing down after the first. Maybe it took the edge off the loudness, but the breathing frequency was still the same, about 50 breaths/min, or more..
I was desperate to help her, so I called the nurse and asked if she could have a little more.
Much later on I read that breathing fast is not necessarily a sign of pain. I thought she was in such distress.
I think it was me who was in pain and I wish the nurse would have explained to me why she was breahing that way, but she didn’t say a thing.
My mother lived in a nursinghome for 15 years, paralysed from multiple strokes.
Forgiving oneself is hard. I saw my mother trying to tell me no with her eyes when she understood that she was going to get a second shot of morphine, and when the needle was about to touch the skin of her belly, she tried to withdraw, my paralysed mother..
I noticed all of this, but I couldn’t stop the nurse from continuing with what she was doing.
I still can’t understand why. Maybe because my mom had given me that look before, for example when I tried to feed her and she didn’t want it, or when we were going to get a feeding tube for her…
Or maybe I was so dedicated to trying to calm my mother down. I was trying to rescue her from death, I thought that hard breathing would make her heart stop.
But in trying to rescue, to fix things, it turned out I did the opposite:(
We had been by her side for days, but one morning we asked the nurse and doctor if there wasn’t one small chance she could live on ( I know this sounds crazy), but she seemed just like she used to, except that the breathing sometimes was strange.
They agreed! Later on admitting that they knew there wasn’t a chance, but they said there might be-they lire, for our sake!! This is what I think brought us into this emotional whiplash the last night. First she was dying, and then she wasn’t..we were so confused.
My brother had gone home during that day, hopeful, and I went to bed an hour before she passed, thinking she could rest( after the morphine) and we would meet tomorrow, a person from the staff went sit with her. My God, we were in such denial! She had been ill for 25 years and we had gone through so many crisis..
But what really hurts me us that we didn’t say goodbye. We told her how much we loved her all the time, but this not having a farewell has destroyed my life, I hasten my mother’s death and I went to bed:(
When I truly began to understand what has really happened, about 6 months later, I totally fell into pieces and I tried to communicate with the nursing home, and also asked for my mom’s medical journal.Begging them for an explanation.
But when I read it, it turned out they had changed the the times of when the shots were given, so it appeared as though it wasn’t because of the morphine that she died that night.
Sorry for this long post. It’s been 9 years now and from time to time I fall into this deep black hole blaming myself for my mother’s death. I find it extremely hard and heavy to carry.
We were very close and I always tried to make her life better for her. It breaks my heart that it ended this way.
This post was actually to say to all of you who had dying parents with rapid breahings, you are not alone. And to ask you, Barbara, is it common that people die in this kind of breahing, or does it always transform into Cheyne-Stokes and slow respirations begore they pass? I wonder how much longer my mom would have stayed in that awake state with that breathing?
One question always remains: How do you forgive yourself?

BK Books replied:
HI Karin, we’ve corresponded about your mom before and the guilt you are carrying. Nine years is a long time to not forgive yourself. I know you wrote her a letter and that it didn’t do much to ease the anguish you feel. You might try another letter and this time write her about the guilt you feel in letting her die. "Mom, I’m so sorry. I wish I had done things differently. This is not how I wanted you to die. I didn’t want you to die EVER. I will always want you with me. I feel your death is my fault. I’m sorry I let you die " Karin, from what you have told me I believe your mother’s death was no one’s fault, certainly not yours. Her body, after all the years of illness, couldn’t continue and she died. No one’s fault, not yours, not the nursing home. If anyone is at fault it is the physician who was not honest with you about how close to death your mother was. No matter how much anyone tells you it isn’t your fault it will have no effect as long as you believe it was your fault. Since that is what you believe, ask her for forgiveness. As a mother she will forgive you. From the sounds of her last years she was probably grateful to be free of the heavy, cumbersome body that no longer worked for her. To answer your breathing question, depending upon the disease or body condition in old age breathing at end of life comes in many forms. It can be fast, it can be slow, it can be loud, it can be gaspy, it can be silent, it can be congested; none of it normal for everyday living, all of it normal for dying. Blessing! Barbara PS: Karin I am going to edit your letter to me and write a blog. You are not alone in the feelings of guilt you carry. From our previous correspondence I know you want to help others. If it is not okay, drop me a line and I won’t write it.


In reading so many examples of labored breathing and rapid heart beats, so difficult to witness in the final hours/moments (and having witnessed it myself when my father recently died) it truly seemed as if the soul situated in the heart was trying to push out of the body to make its way to heaven. How an aging human body can tolerate the process and not explode is beyond me.
BK Books replied:
Luna, yes, it is hard work to get out of the body, hard for us to watch as well. My blessings to you. Barbara


My mum died last year from cancer and I am still haunted by her death. Like Linda’s mother, she was breathing very fast and heavily, as if she had just finished a sprint race, so much so that her head and neck were lifting off the bed with each gasping breath. This went on for a couple of hours I think. I’ve tried to blank it but I can’t. We stopped her fluids and now I wonder if we dehydrated her to death. Was it painful? Who knows. It certainly didn’t look peaceful. She breathed like that until one breath just stopped, which I assume was a heart attack and then she was suddenly gone. I can’t move on until I know if this was a horrible way to go or not.
BK Books replied:
Hi DJ, it is so hard watching someone we love when they are in the labor to release from their physical body. When they are that little chick working to get out of the shell we call a body. It’s hard work. I do not believe your Mum being dehydrated was causing her struggle. You asked if “it was painful”? In the hours before death the struggle looks painful. I believe the person is so removed from their physical body, so much has already shut down, that they are not experiencing their body and what it is doing in the same manner they would if they were not dying. I believe the person can hear but as if from afar, distant sounds. DJ, write your mum a letter. Put all your thoughts and concerns about your relationship and those last hours down on paper. Let the tears flow as you tell her everything you’ve wanted to say and are thinking and feeling. Then burn the letter and scatter the ashes to the wind. As you watch the ashes scatter know your mum is free of these earthly bounds and she would want you to be free of the memory of her labor to leave this world. Let go of that memory and hold on to the love that bound the two of you. Blessings! Barbara


Just so Linda (comment 11/25/20) knows she is not alone, my dad did that same horrible very rapid breathing for over 48 hours. He was on his side, holding the rail for the entire time. The nurses gave him many doses of morphine, all to no avail. It was extremely painful to watch, but we were told with all the morphine administered he was not in pain. He really struggled to leave this body.

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