In Dungeons and Dragons 5th edition, the introduction of lasting injuries and effects promises to revitalize the way players approach the game. By infusing combat with the possibility of enduring consequences, this elevates the significance of each skirmish beyond the individual encounter. Health is no longer just hit points to be replenished with the wave of a hand or a nap; it becomes a strategic element of play managed through clever player choices. This shift introduces a layer of tactical depth missing in the vanilla game, requiring players to think critically about their characters actions and their potential long-term impacts on how the adventure plays out.

An enhanced focus on increasing tension through lasting injuries does more than just increase stakes; it weaves a tighter bond between the player characters. Characters are encouraged build allies and actively participate in the healing and protection of their comrades, adding a rich layer of interdependence that was somewhat underdeveloped in the core rules. The sense of triumph following a narrowly won battle is exponentially heightened when the victory is hard-earned and comes with its own set of challenges to overcome. Through this approach, Dungeons and Dragons 5th edition rekindles the flame of classic sword and sorcery adventures, making every step of the journey feel impactful and every success a testament to the players’ strategic prowess and camaraderie.

Exhaustion Condition and the Modern Adventurer

The D&D design team presented an intriguing update to the exhaustion rules during their Expert Class Unearthed Arcana Playtest in 2022. In it, they replaced the confusing six-level exhaustion rules, which many thought were useless and confusing, with a more gradual system adding a simple -1 per level of exhaustion. A typical house rule in many D&D games has been to add a level of exhaustion to each character who drops to 0 HP or fails a death save. Using a similar house rule with this new Exhaustion Condition, but requires a bit more thought and modification to make it enjoyable, manageable, and fit well into the game.

Having never included the Exhausted Condition in subsequent UA releases, it looks like this may not be included in the DnD 2024 update, set to release later this year. Possibly they may make it into the DMG as an optional rule, but this expansion adjusts to the rules change in a way that integrates better with class abilities and the intent of the overall rules. It also integrates with the natural and mechanical healing rules in a natural way.

To that end, I suggest the following house rule I have been refining over the last year. (You may have seen some of my previous injury condition posts).

A woman with bow and arrow, standing defiantly, with scrapes and bruises on her face.

Exhausted [Condition]

Characters accumulate exhaustion through various means that slowly reduce their effectiveness.

  • Levels of Exhaustion. Exhaustion is cumulative. Each time a character receives the condition, they gain 1 level of exhaustion. A character may have a maximum of 10 levels of exhaustion and die once they exceed that. As an optional rule, the DM may choose to use the character’s CON score as the maximum level of exhaustion.

  • d20 Rolls Affected. The character subtracts their levels of exhaustion from all d20 tests.

  • Spell Save DCs Affected. The character subtracts their level of exhaustion from their spell save DCs for any spell they personally cast.

  • Gaining the Condition. A character gains 1 level of exhaustion whenever they fail a death save or when they suffer a critical hit. Characters killed through the Massive Damage rules gain their maximum level of exhaustion. The DM may also rule a character acquires a level of exhaustion though other means like strenuous activity, difficult travel, or other circumstances.

  • Recovering. A character removes 1 level of exhaustion per Long Rest.

  • Recovering. (Optional Variant) Immediately after finishing a Long Rest, the character may make a DC 10 Constitution test, removing 1 level of exhaustion on a success. Characters who fail by rolling a 1 gain an additional exhaustion level. A character may gain advantage on a recovery roll if they are being provided medical care, provided hot meals, and in a restful environment, or other conditions as determined by the DM. Characters without adequate shelter or in a very stressful environment roll recovery at disadvantage. When their exhaustion level reaches 0, the character is no longer injured.

Class Ability

Shake It Off. Fighters, Paladins, Barbarians, Monks, and Rangers gain the ‘Shake It Off’ ability at 1st level. As a free action, the character can choose to tap their deep reserves of fortitude to prevent taking one level of exhaustion. They can use this ability once and regain the ability to do so after a Long Rest. These classes gain an additional use of Shake It Off each time they gain the Extra Attack ability.


  • Healing Exhaustion with Magic. One level of exhaustion may be removed by casting Lesser Restoration. Greater Restoration removes all levels of exhaustion.

  • Bring Out Your Dead. Any levels of exhaustion remain with a character brought back to life through Revivify or Raise Dead, up to their maximum. Resurrection, True Resurrection, and Wish bring characters back to life with 0 levels of exhaustion.

Much Ado about Death Spirals

Some express a concern of creating a “Death Spiral” through cumulative injury rules, where penalties lead to further failures in a seemingly endless cycle, is valid yet potentially overstated in the context of these new exhaustion mechanics. The incremental nature of a -1 penalty per level of exhaustion allows for a gradual impact, delaying significant detriment until several levels are accumulated. Moreover, characters possess abilities such as Bardic Inspiration or Aid, offering strategic options to offset even several levels of penalties at a cost. Additionally, the game does not operate in isolation; DMs can incorporate downtime for recovery, and players can proactively seek rest, fostering deeper engagement with the game world. Thus, while vigilance is necessary to prevent overwhelming challenges, these rules are designed to enrich gameplay, not hinder it.


In conclusion, incorporating and expanding the exhaustion rules in a Dungeons and Dragons game adds a whole new layer of strategic depth and emotional engagement. It elevates the stakes of every combat encounter, pushing players to think more critically about their actions and encouraging a greater sense of camaraderie within the party. This not only enhances the realism of the game but also enriches the storytelling, creating a more immersive and memorable experience. While it’s a more challenging way to play, the rewards are substantial, making each victory a testament to the players’ resilience and teamwork.