Complete Suffocation Rules for D&D 5e – Hold Your Breath!

Last Updated on November 5, 2023

How Does Suffocation Work in 5e?

I’ve put this into a simple table for you.

Constitution	Hold Breath (Time)	Suffocation Rounds
1-9	30 Seconds	1 Round
10-11	1 Minute	1 Round
12-13	2 Minutes	1 Round
14-15	3 Minutes	2 Rounds
16-17	4 Minutes	3 Rounds
18-19	5 Minutes	4 Rounds

Your Con score determines how long you can hold your breath.  Once you hit that threshold, look at the Suffocation Rounds to see how long you have before you hit 0 hit points and start dying.

If you hit 0 and are still under water, you can NOT stabilize until you can breathe again.

Let’s look at the official rules to break it down further:

Hold Your Breath

“A creature can hold its breath for a number of times equal to 1 + its Constitution modifier (minimum of 30 seconds).”

Player’s Handbook, pg. 183

This is easy enough. A character with a high Con modifier of +4 would be able to hold their breath for 5 minutes, an impressive feat by any means. 

Of course, you’ll notice that there aren’t harsh penalties for having a poor constitution score. Whether your modifier is -1 or -4, you’ll still be able to hold your breath for 30 seconds.

So, if you’re swimming underwater without any added benefits, you have this calculation to tell you how long you can stay there without coming up for air. What happens if you run out of air though?

Out of Breath

“When a creature runs out of breath or is choking, it can survive for a number of rounds equal to its Constitution modifier (minimum of 1 round). 

At the start of its next turn, it drops to 0 Hit Points and is dying, and it can’t regain Hit Points or be stabilized until it can breathe again.”

Player’s Handbook, pg. 183

Now that you’ve run out of breath, the pressure is on. You have a very limited amount of time to get yourself to air before you start to actually die. 

Since time in rounds is going to equate to movement and actions, there’s probably not much you’ll be able to accomplish. Likely, most characters will need to use the Dash action to get themselves out of a sticky situation.

Let’s look at the PHB example again:

“For example, a creature with a Constitution of 14 can hold its breath for 3 minutes. If it starts suffocating, it has 2 rounds to reach air before it drops to 0 hit points.”

Now, 3 minutes is a good amount of time in combat.  That’s 30 rounds.  However, once you start suffocating, you have 2 rounds or you drop to 0 HP.

If you drop to 0 hp underwater death saves wont help you.  Suffocating means you can not stabilize and will die.

Another character can try to drag you to the surface, cast some type of water breathing spell.   

If that seems harsh, we have a homebrew below for you.

Homebrew Suffocation Rules for D&D 5e

Exhaustion Levels after Suffocation – Homebrew

That bit in the rules about dying is pretty rough for our characters who run out of air, so let’s talk about an alternate method.

If your table wants to mess around with some homebrew rules, we’d suggest introducing exhaustion into the mix.

The additional ruling would go something like this: “If a player would become stable but is not able to breathe, the player becomes stable AND takes a level of exhaustion each round that they are unable to breathe.” 

This adds potentially 7 extra rounds between a character and death. While it’s certainly not for everyone, we think it’s a solid option for more forgiving tables.

Suffocation Saving Throws – Homebrew

The rules as written aren’t bad, but they do take a lot of the uncertainty out of the situation. 

The ability to hold your breath is easy and straightforward, but if we want this to be a bit more exciting, let’s start with the easy part. 

With our new rules, all creatures can hold their breath for 30 seconds.

Next, we’ll add in Suffocation Saving Throws. If a creature has run out of breath or is choking, it must make a Constitution saving throw at the beginning of each of its turns until it is dying or until it regains the ability to breathe. 

The DC of this saving throw starts at 10.

On a successful save, the creature is able to hold its breath, and the DC increases by 1. On a failed save, the creature must roll its Hit Dice. 

It loses that number of hit points, and the DC is increased by that number +2. If the DC reaches 30, the creature drops to 0 hit points immediately.

With this option, there is a continuous consequence for trying to hold your breath underwater beyond an average amount of time. 

Instead of a ticking clock that can be perfectly planned for, this ruling makes attempting to hold your breath a dangerous and exhilarating activity. 

If you’re trying to hold your breath while also fighting, that clock is going to feel even smaller.