Complete Suffocation Rules for Dungeons and Dragons 5e

Last Updated on April 25, 2023

Dungeons and Dragons is a roleplaying game that lets you do anything you want with your fantastic characters. From summoning giant monsters to mastering the way of the blade all the way to toppling an empire, there’s no shortage of things you can accomplish. Of course, all of that freedom means we can run into some less exciting situations as well.

Today, we’re looking at the D&D 5e rules for suffocation and breathing. We’ll go over how they work, discuss how and why these rules are the way they are, and then get into some more exciting topics as well.

How Does Suffocation Work in 5e?

In D&D 5e, suffocation is what happens when a character loses the ability to breathe. There are a lot of ways this can happen, such as drowning or being choked, but we don’t need to get into those right away. First, let’s look at the official rules.

“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. Our constitution modifiers often dictate things relating to our health and well-being, so it makes sense that it would come into play here. 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?

“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.

This also brings up the concept of choking, something that isn’t actually defined elsewhere in 5e. This might bring to mind choking on food or being choked by someone else. So, we suggest this definition: “A character is considered to be choking if they are suddenly unable to breathe due to some outside factor.”

With this definition, running out of breath is something that happens when we’ve made the decision to “stop” breathing and actively hold our breath while choking covers any unintentional situations.

Dying from Suffocation in 5e

That bit in the rules about dying is pretty rough for our characters who run out of air, so let’s talk about it a bit more in depth. How do characters gain the ability to breathe again?

Well, this is all dependent on the situation we’re in. It makes a lot of sense that the rules for suffocation were included in the Environment section of the PHB. If we’re underwater, gaining the ability to breathe is going to look a lot different than it might if we’re being choked by an enemy character.

The character that has actually dropped to 0 hp because of choking isn’t going to have much to do in any situation. Instead, it will be their allies’ responsibility to negate whatever effects caused the character to choke in the first place.

Here’s the thing though; stabilizing is completely dependent on your ability to breathe. That means even if you roll your death saving throws perfectly and would manage to avoid death in normal circumstances, you would still end up dying if you can’t breathe.

Now, there is a potential workaround here since dying is definitely not a high priority for many D&D players. 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 but takes a level of exhaustion each round that they are unable to breathe, starting the round after they are stabilized.” 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.

Homebrew Suffocation Rules for D&D 5e

The rules as written aren’t bad, but they do take a lot of the uncertainty out of the situation. In a game where the roll of the dice is just as important as the roles we play, we can definitely come up with a more exciting option.

Rather than working with the passive suffocation rules, let’s create something that is more active and allows us to roll a few more dice. We can do this by replacing some uses of the Constitution modifier with some Constitution saving throws. 

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. Of course, characters with high constitution scores or any additional benefits will be able to hold their breath for a much longer 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.

Final Thoughts

Suffocation is a very real threat in D&D, although it is far from the only thing to put characters’ lives at stake. If you’re running a campaign where the threat of suffocation is far more common, you might want to make this more exciting so your characters won’t be the only ones holding their breath and waiting for the roll of the dice.

As always, happy adventuring!

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