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Exhaustion for Death, Devilry and Derring-Do

Not so long ago I quoted exhaustion as being one of the 15 reasons I love 5th edition Dungeons & Dragons.

Given the often deranged mental gymnastics we have to do to make hit points make sense, it’s great to have a second, separate mechanic that measures life force, and moreover one that – unlike hit points – brings with it cumulative penalties as you head towards death.

The Player’s Handbook states that you can gain exhaustion from starvation, and prolonged exposure to hot or cold temperatures, while the mechanic crops up in certain other niche abilities, such as the spell sickening aura or the berserker’s frenzy ability (I remixed the berserker for you here by the way… it’s a lot more fun now!). I also recall that the official rules governing chases are effectively a contest in who gets exhausted last. In the latter instance, levels of exhaustion are temporary.

Generally speaking, however, exhaustion doesn’t crop up much in the core D&D rules. Given how clean and simple the mechanics are, I think they could be utilised to greater effect. Some ideas to get the ball rolling…

“I’m tired, but you should have seen that Heroic Surge!”


A long time ago, I proposed to one of the DMs in my group that being reduced to a 10th of your hit points should incur one level of exhaustion, and being on 1 hit point (‘Last Legs’ condition, you could call it) should come with two levels of exhaustion.

From that he created his own homebrew rule: when you are reduced to 0 hit points, you incur two levels of exhaustion. That’s pretty prohibitive (given that it takes a long rest to recover a level of exhaustion, and that folks who are reduced to 0 hit points are often reduced to 0 hit points twice… as they are very vulnerable), but I like the realism it produced – and the actual fear of death. He also made it slightly easier to get rid of exhaustion, by allowing the lesser restoration spell to remove one level (usually this requires greater restoration).

Today, it’s a very common house rule, in tables around the world, that being reduced to 0 hit points incurs one level of exhaustion, and I would definitely encourage DMs to build some kind of relationship between being knocked to 0 hit points, and being exhausted. It’s made our games much better (no more waiting for someone to be knocked unconscious before using your healing spells on them for example).

My current house rule would be, if you are brought back from 0 to 1 hit points you are ‘Seriously Wounded’ and have two levels of exhaustion. Once you are brought back to 2 hp or above you are ‘Wounded’ and have only one level of exhaustion, which you can remove in the usual way, i.e. via a long rest.

Or, for more realism, I might even make it three levels of exhaustion when on 1 hit point (F*cked condition), down to two levels as you get healed, and then I’d stipulate that a short rest is enough to remove one level of exhaustion sustained in combat.

Note: Another (even harsher) way of ensuring folks feel the effects of being reduced to 0 hit points is to roll on the Lingering Injuries table to see what blow took them down.

Arcane Exhaustion

One of the locations I created for my ‘Inside the Great Library’ chapter of my Candlekeep Murders adventure was the Whispering Dome, part of the Hall of Momentous Deeds library. Anyone who meditates in the dome for 1 minute hears the inspiring words of a hero, echoing quietly in the chamber, urging them on to greatness of their own. One of the phrases a player might hear, spoken by Lavinia the wizard, is: “The Weave never runs dry… sometimes you just have to dig deep to use it.” A player who hears this phrase gains the following benefit: when they run out of spell slots, they may regain one spell slot of their highest level (maximum 5th). When they cast a spell using this regained slot they gain a level of exhaustion.

I always found it a bit weird that when a spellcaster runs out of spell slots they suddenly can’t cast a spell they know and have mastered… it’s like imagining a musician who’s unable to do an encore! Obviously as a game mechanic, it’s pretty much essential to limit spellcasting, but it’s another little niggle against realism (this is NOT your cue to comment that magic is not realistic!).

On the other hand, if we imagine that casting high level spells puts a strain on the body and mind perhaps we have another, more credible way of limiting casting. A system whereby spellcasters (re)gain slots by taking on levels of exhaustion feels like a good give and take, while those DMs that want to redress the oft-lamented imbalance between spellcasting and martial classes could even include exhaustion checks on using one’s allotted slots, so that spellcasters have to be more judicious about their high level casting.

Any homebrew here is going to be very controversial, but I leave the idea out there for discussion!

Heroic Surge

Sometimes a player decides to do something undeniably balls-to-the-wall heroic, like single-handedly holding the bridge while their buddies escape a rampaging horde of orcs. Having basically decided to commit suicide, their turn comes around and they attack the nearest orc, rolling a 3. The bards will sure sing beautifully and sorrowfully about that epic last stand!

Again, using the give and take principle, I plan to experiment with allowing players to take a level of exhaustion to gain an Action Surge. I might add that they need to have and use inspiration as well, to access this ability, and I may place some other restrictions on this ‘Heroic Surge’ – you can’t do this if you’re already exhausted already, for example (making this a once a long rest max. ability). Alternatively, I may offer a player a Heroic Surge when they propose something particularly heroic, as a kind of reward, and an insurance policy against anticlimactic results.

Giving powers away willy nilly can cheapen and unbalance the game… but when heroes attempt extraordinary feats, and are willing to pay a cost to do so, I’m happy to give them a helping hand. Now where’s my “Dungeon Master of the month” award?

Guys, seriously…

Concluding Thoughts

Anyway, those are just a few thoughts on exhaustion and how else it could be leveraged as a mechanic on your D&D table, that I wanted to share.

As ever, please leave your thoughts on my thoughts in the comments section. And also do please share any examples of homebrew and house rules you have regarding exhaustion. I’d love to hear them!


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  1. Keith

    I do like the exhaustion rules in 5e. I had toyed with trying to do something like it way back in AD&D but never followed through with it. I like the 2 levels of exhaustion for 1 hp and then remove one more when they get more HP but I would probably set it a little higher, like 10-25% or something like that. 10% sounds fair. But I would make an exception for half orcs on this. I would not hit them with the exhaustion at all when they first use their relentless endurance as it is a racial thing and since it can only be used once per long rest it makes them a bit more tankier than the rest of the races, especially a pally that can heal themselves. as for your award…….

  2. Justin

    We play with 1 level of exhaustion – not on dropping to 0hp but on being magically healed back up. So if you are just stabilised and wait your 1-4 hours, no exhaustion. that seems to me to make more sense: it’s the immediate magical recovery that’s exhausting to the body, not the initial knockout. We also remove exhaustion with lesser restoration (how is it that by RAW it’s harder to remove exhaustion than raise the dead???).

    FWIW: your “2 exhaustion on 1hp, remove 1 at 2hp” rule would almost never occur, since 99% of recovery from 0hp happens via healing magic that brings people back up to at least 2hp. And, assuming someone did recover to 1hp (perhaps via a 20 on a death saving throw), it’s not clear to me why a healing word to get from 1hp to 5hp should also remove exhaustion.

    Re: arcane exhaustion – I love the concept but as you say, it’s not spellcasters who need the love. If anyone should get it though, I’d suggest its sorcerers – partly as they are generally regarded as a bit weaker than other full casters, partly because it fits what I think is the class concept. I’ve even wondered about a ‘power surge’ bonus action homebrew idea that gives sorcs a spell slot back to cast in the same turn, but costs *hit points* (and reduces max hp for the rest of the day) – even potentially to 0hp in a ‘collapse after the devastating final spell that saves the day’ moment, a la Yennifer in the Witcher TV adaptation, and many other fantasy tropes.

    Re: heroic surge: love it! Although if a player is outright sacrificing their PC, I’d almost always want to just let them auto-succeed, and get to narrate the scene as they see fit in a reverse ‘how do you want to do this?’ moment.

    • Keith

      A lot of players that ‘work’ the system using the numbers and such will have a pally heal 1 HP on a character to get them up. Thus even a level 1 pally can bring peeps back from 0 to 1 HP 5 times and without exhaustion then 1 hp is as good as 100 for fighting. At least this way, a pally may need to invest 3-4-5 HP of healing minimum to get the character out of 2 levels of exhaustion using my 10% idea. This is why I mentioned 10% and the more I think about it, I think it should be at least 20-25%, just to prevent this from getting out of hand.

    • duncan

      My thoughts on your thoughts on my thoughts…

      “it’s the immediate magical recovery that’s exhausting to the body, not the initial knockout. ”

      I actually see it completely the other way!

      “(how is it that by RAW it’s harder to remove exhaustion than raise the dead???).”

      I know, right? Kinda crazy…

      “FWIW: your “2 exhaustion on 1hp, remove 1 at 2hp” rule would almost never occur, since 99% of recovery from 0hp happens via healing magic that brings people back up to at least 2hp.”

      Ok I think we have accidentally slipped into a house rule that with three death save passes you regain 1 hp (not become stable, with 0 hp). I just had to check the PH to clarify that we were going off grid there!

      On this topic however, i still believe there’s justification for giving out exhaustion for falling to 1 hp (not recovering to 1 hp)… i.e. the ‘Last Legs’ condition I hint at in the blog post.

      Also, a house rule I have thought about implementing and might actually try is that when a creature with 0 hp receives magical healing, they are restored to 1 hp only (not higher).

      “And, assuming someone did recover to 1hp (perhaps via a 20 on a death saving throw), it’s not clear to me why a healing word to get from 1hp to 5hp should also remove exhaustion.”

      In my imagination, being that low on hit points just means you’re absolutely shattered, bleeding, bruised etc. Close to death. Just getting a bit higher is enough to be able to fight relatively normally.

      Meanwhile seems like we are thinking on similar lines re: Arcane Exhaustion, but using different mechanics. Did someone in the comments suggest 1 level of Exhaustion per level of the spell slot recovered? (EDIT: Yes, it was Rick!) In which case you could take 5 / 6 levels of exhaustion to recover a 5th / 6th level spell and achieve your Yennifer moment. That would actually be pretty cool!

      • Justin

        Hmm, I do like exhaustion per spell level but oh man, you’d want to think carefully about recovering a 6th level spell slot!

        But also I feel like recovering a 3rd level slot should be as taxing for a 5th level sorcerer as recovering a 5th level slot is for a 9th level sorcerer, and only hit point penalties (say, 5hp per level) can account for that.

        I see now with your 1 exhaustion at 1hp (on the way down, not just the way up) that your idea makes sense, although I tend to agree with Keith about a higher % recovery. But at this point the complex mechanics might risk getting in the way of the flow of the game.

  3. Maltt Bynad

    I just changed the house rule from “If you fall to 0 HP, you gain a level of exhaustion” to “If you fail a death saving throw, you gain a level of exhaustion.”

    I think this is fine for most styles of play. Too much exhaustion can lead to a quick death spiral, but even just the threat of it applying is enough to make the other PCs more attentive to a fallen party member. This also gives the allies a short window in which to work, or risk a failed death save and the accompanying level of exhaustion.

    • Rick Coen

      We use a stylized “wound” rule that slightly impedes magical healing, and rolls HD with dsiadvantage (in place of the Optional Rule for Injuries). So failing a Death Save gives you a Wound. Wounds, like Exhaustion, heal one per day… and impede the recovery of both Wounds and Exhaustion! So dropping to 0 gets you Exhaustion (the shakes, we call it, making skill checks difficult)… but leaving your ally down risks both Death and lingering Wounds that accumulate and impair!

    • duncan

      Yeah I think I’ve seen that variant before. Makes sense, and will give it some thought.

      I would favour a system that gave out exhaustion more readily, but also made it easier to recover from… otherwise, as you say, a negative spiral occurs or characters are always labouring under exhaustion which can get frustrating!

  4. Rick Coen

    We use “hit 0hp, gain a level of exhaustion”, but we also added “at the end of a Short Rest, if you have one and only one level of exhaustion, CON save DC 10 to remove it”.

    The first part means being brought up with a Healing Word (or Lay on Hands) to just 5hp or so probably means you’re going back down soon – and gaining *another* level of exhaustion. In a recent fight with acid-spitting purple worms, the cleric ended the battle with three levels of exhaustion, and the wizard ended with two. You can’t “game” hitting 0 hp…

    (Incidentally, we also play with Wound Penalties. -1 on attacks and checks at 50%, -2 at 25%, and -3 at 10%. If the paladin only brings you up to 1hp, you’re not very useful!)

    The second part means you can recover quickly, if it was just this one isolated moment of shock. (Also, this serves as our fix for the Berserker. Two for one house rule!) But if you are already taxed (like from a Forced March), or do the 5e hp yo-yo, the repeated trauma is going to affect you for days!

    Anyway – I like the Heroic Surge idea. Especially since my players do struggle with Exhaustion, being able to dig deep and get an extra turn at the cost of exhaustion is a cool idea to play with. Also, every level of exhaustion mechanically hurts (just 1 level is disad on ability checks = grapple-bait!), where even taking 20 damage might not matter at all. For that matter, I’m okay with letting a caster get off an extra spell when “tapped out” at the cost of exhaustion… but I might have it be 1 Exhaustion per spell level! (or maybe two spell levels)

    • duncan

      I like all those rules, but they seem to punish martial characters more than spellcasters right? As they can always use AoE spells and ignore the wound penalties? (Then again, you could say the same about levels of exhaustion!).

      Btw, regarding being reduced to 0, my biggest issue is not their teammates leaving them bleeding out…. needs must on occasion! It’s them receiving a spot of healing and springing up and acting if nothing happened the round before. Wound penalties help deal with that, although exhaustion limiting movement can be even more realistic… with two levels of exhaustion you can only stand up from prone (half your move!) on your turn, or else crawl somewhere. (Again those damn spellcasters are the least affected, as they can deal damage from range).

      Good idea about 1 level of spell per level of exhaustion!

      • Rick Coen

        Does this system punish the martials more? Not that we’ve seen. For starters, with better AC and more HP, they rarely hit 0hp – it tends to be the squishier casters that get dropped. (But not the rogue, who is always like 60′ away, sniping.) Secondly… they tend to have better CONs, and CON saves. (Note: side benefit for the Sorcerer!) However, I acknowledge that the casters can work around the attack penalties by casting save-spells. We toyed with having the penalties affect those too, but decided that was a bad plan. (Note that the Warlock’s Eldritch Blasts *are* impacted.)

        So when the wizard got hit in the face with a “6d6 ongoing until washed off” acid gob from the purple worm, he had nothing on his mind but getting to the river. And he fell to 0hp before he got there (BAM, disad on checks), was healed 7 by the bard, ran a few more steps, and fell to 0 hp. (BAM, half move). He was healed by the Celestial Warlock for 11, was helped to his feet, stagged forward, and fell to 0 hp. At this point the fighter got there, and rolled the unconscious wizard into the river! Then the cleric hit him with a 3rd level Cure Wounds for 21, bringing the wizard all the way up to “just over bloodied”, and (after a couple rounds of roleplayed panic and shock that were not “required” by the rules), flew into the air and blasted the purple worm with a Lightning Bolt. But it took him 6 days to recover from the exhaustion and the two Wounds he took from the massive acid attacks.

        [In this fight, I also was going to implement “if an attack reduces you to 0hp *and* the remaining damage is greater than your CON SCORE, you automatically fail a Death Save” (and take a Wound). Technically I *did* implement it, but the dice favored the PCs in this circumstance, and neither of the PCs who were dropped to 0 triggered the effect!]

  5. Duncan Idaho

    I’m a big fan of Exhaustion and I’m glad to read that other DMs use exhaustion in conjunction with being brought to 0 hp. I’ve toyed with having 1 level of exhaustion happen automatically at 0hp with an additional level potentially occur based on a CON save.

    I wish more mechanics interacted with Exhaustion. For example, I’d like to see necromancy spells that cause exhaustion or healing spells that grant extra Hit Dice at the cost of exhaustion (similar to Justin’s comment about taking exhaustion when magically healed.) For that matter, I’d like to see more effects that interact with Hit Dice– ex a druid healing spell that allows a character to expend Hit Dice to gain hit points outside of a rest (similar to a 4e healing surge) or a necromancy spell that exchanges hit points on one creature for hit dice on another (with some losses, of course as necromancy isn’t perfectly “efficient.”)

    • Rick Coen

      I like some of these spell ideas!! Just triggered a bunch of spell possibilities in my mind (and class features and warlock invocations, and….) to go off and homebrew for my campaign!

      • Duncan Idaho

        Rick, did you ever write up those spells and abilities?

        • Rick Coen

          I appreciate the follow-up, Duncan. I started working on a lot of ideas for abilities and HD interactions, and a couple for Exhaustion interactions. When I started discussing the ideas with my players… they all got shot down. The most charitable response was “Maybe hand a couple of these out as Boons, but not as core rules.”

          Here are a few examples (in simple form, little to no fluff text):
          — Heroic Effort: Action Surge at the cost of 1 Exhaustion. Max 1/rest. [Your rule, Duncan! 🙂 ]

          — Overcasting: Regain an expended spell slot and use it immediately to cast a spell, at the cost of 1 Exhaustion PER LEVEL OF THE SLOT. (yes, that means a 6th level slot or higher auto-kills you… but you cast it first!)

          — Internal Magic (Sorcerer): Spend HD during a Short rest to regain Sorcery Points (2 per HD spent).
          — Blood Magic (Sorcerer): Spend and roll HD at the time of casting; add damage to the spell equal to twice the amount rolled (no CON mod).

          — Blood Rage (Barbarian): Spend and roll HD up to CON mod (min 1) at the start of a rage; gain that number of Temp HP (no CON mod).

          — Deep Breath (Fighter): When using Second Wind or Action Surge, you can spend and roll HD up to half your Fighter level, gaining the amount rolled as healing (no CON mod). Once/long rest.

          — Centering Step (Monk): When using Step of the Winds or Patient Defense, you can spend and roll one HD, gaining the amount rolled as healing (including CON mod). Once/long rest.

          For spells:
          — Change all d8-based (or larger) healing spells to “HD of the target”. [Multiclass characters use highest HD first, then lesser, equal to the number of dice of the spell and beyond. Cure Wounds 1 on a Fighter 2/Bard 3 heals 1d10; Cure Wounds 6 heals 2d10+4d8.]
          ——– Spells that heal less than a d8 are unchanged.
          ——– Spells and effects that heal a flat amount are increased 25% if the target uses d10 HD or larger, or lowered 10% if the target has d6 or lower.
          — If the target is at 0hp, magical healing SPENDS a HD from the target; if the target does not have a HD, it gains a level of Exhaustion.

          Lifestyle / Camp Quality (stolen shamelessly from someone else)
          — Wretched: recover 2 fewer HD
          — Squalid / Poor Camp: recover 1 less
          — Poor / Normal Camp: normal
          — Modest / Amazing Camp / Normal Inn: recover 1 extra
          — Comfortable / Nice Inn: recover 2 extra
          — Wealthy / Amazing Inn: recover 3 extra
          — Noble / 5-star Hotel (10gp+/night): recover 4 extra

          There are other ideas, but just ideas… I abandoned the effort when my players rebelled. (But I kept the Lifestyle/Camp Quality rules as my own guideline!)

          We still use the combat and injury rules I posted before, though. And now, when a hit takes you to a negative value = your CON score, it’s an automatic Death Save failure. Last fight, the fighter was ground zero to an exploding undead, with 4 HP left (CON 14). It exploded for 26 damage, and he failed his save. That took him to -22, which is more than his CON, so he went down (taking a level of Exhaustion for hitting 0), and took a Lingering Injury (for 25% of his MAX HP in a single blow), *and* an automatic Death Save Failure (for -HP > -CON)… which itself caused a second Lingering Injury (any failed Death Save)! Bad bad luck…. [He spent a Luck Point, actually, to reroll the save, making it, taking only 13 damage, and simply falling to 0hp and taking a level of Exhaustion!]

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