Drowning and Suffocating
When you run out of air, you fall unconscious and start suffocating. You can't recover from being unconscious and must attempt a DC 20 Fortitude save at the end of each of your turns. On a failure, you take 1d10 damage, and on a critical failure, you die. On each check after the first, the DC increases by 5 and the damage by 1d10; these increases are cumulative. Once your access to air is restored, you stop suffocating and are no longer unconscious (unless you're at 0 Hit Points).