Exhaustion has a problem in 5E.
It's just too damn punishing.
Failing to get a full night's sleep, trekking through extreme heat or extreme cold (though the latter can be mitigated with some warm clothing,) failing to eat enough in the course of a day - these all inflict (often with a Con save to avoid it) Exhaustion.
But Exhaustion causes problems that really compound over time - the first level, disadvantage on ability checks, is more of an annoyance. But when you speed is halved, you start getting disadvantage on attacks and saving throws, your HP is halved, and you just start spiraling, the ultimate meaning of this is that basically just one level of exhaustion prompts any player to stop everything and try to remove the exhaustion. It just kind of interrupts the narrative.
Now, as a DM, you might be tempted to put them in a position where they can't just clear it easily by taking a day off - maybe you have them trapped in some dangerous region or there are bad guys hunting them.
But on the flipside, because it's so damn bad to get more than a level or two of this debuff, you risk overtuning the challenge of your adventure if you don't give them opportunities to clear it.
I don't know whether this change is making it live to the PHB, though there are some comments and signs from various YouTubers that suggest it will, but here's the version that was found in one of the early UA playtests:
Rather than a series of different debuffs that end in death, Exhaustion in this system is actually a little closer to Stress as introduced in Van Richten's: each point of exhaustion reduces your attack rolls and ability checks by 1 (I believe saving throws are exempted, which is smart given that usually avoiding exhaustion requires a save) and on top of that, the DC for saving throws you force other creatures to make is also reduced by 1. If this reaches 10, you die (so we're keeping that aspect, but allowing a few more levels of exhaustion before we hit it).
This last part I think is really smart, because without it, you might find yourself in a situation where a Wizard or Druid who primarily casts spells wouldn't really be all that adversely affected by it. Now, regardless of your build, exhaustion is going to penalize you.
But the best part is that I think this is not as bad of a debuff. Reducing any of these values by 1 is only a 5% nerf. It'll mean that you're succeeding and your enemies are failing a little less often, but only to a small degree.
And that means that players can afford to let it stack up higher.
Like, no one loves it when the target they're attacking is behind cover, but you'll usually be willing to try even if they're getting a +2 or even +5 to their AC. You can still be pretty effective even if your bonuses aren't quite where they normally are.
And that means that Exhaustion can be a far more common threat.
Consider this: under the 2014 rules, a monster whose attacks forced a character to make a Con save or become exhausted would be a balancing nightmare. This thing gets its thing off three times on a PC and you're looking at someone who is going at half speed and has disadvantage on everything, and it'll be days before they're back to normal unless you spend some really expensive diamonds and 5th level spell slots.
But under this system... it feels kind of fair. It's definitely still scary, but rather than letting this monster utterly ruin the party's day, you now just have an incentive to focus-fire it.
See, I like having lingering problems for the party to deal with. I think it allows you to tell more dramatic stories. I think using a monster that can inflict exhaustion could really work well in a Ravenloft-like adventure, maybe striking at the party before retreating to take its own short rest while the party is getting this slowly building debuff that cannot be cleared as easily.
I will also say that this could make the Ranger's eventual ability to clear a point of exhaustion on a short rest far more useful. Exhaustion is so rare in today's games that that feature is kind of nothing. But if monsters are frequently inflicting this condition, the Ranger becomes the person who is far more capable of tirelessly pursuing those kinds of monsters.
The fact that almost everything resets on a long rest is useful for bookkeeping, but it ties our hands a bit as storytellers. I think an Exhaustion that is balanced enough that you can use it more freely would really give us the opportunity to tell a tale of grueling conflict.
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