Sleep Disruptions

You have trouble sleeping, or your sleep is disrupted in some way. Note the rules on p. 87 of the Basic Rules regarding rest and other fifth edition sources regarding exhaustion. As elves and other creatures of fey ancestry don’t sleep, the GM can determine whether they should reroll or whether this affects their meditative condition. If you have multiple traits, you may choose one or more Baseless Emotions as one or more of them.

d100	Sleep Disruption
1–6	Confusional Arousals
7	Exploding Head
8–17	Hypersomnolence
18–40	Insomnia
41–44	Night Terrors
45–50	Nightmares
51–52	Sleep Aggression
53–55	Sleep Behaviors
56–60	Sleep Enuresis
61–62	Sleep Paralysis
63	Sleep Sorcery
64–86	Sleep-Related Breathing Disruption
87–88	Sleep-Related Hallucinations
89–93	Sleep-Related Movements
94–97	Sleep-Wake Disruptions
98–100	Sleepwalking

• Confusional Arousals. You wake from sleep and act as if under a Confusion spell for (IE)d10 minutes and then return to sleep. You retain no memory of waking up.
• Exploding Head. As you awaken from sleep, you hear loud explosions. They startle you, and you must succeed on a DC 5 + (IE) Wisdom saving throw or have disadvantage on all Intelligence and Charisma checks for (IE) rounds but have +1 to initiative rolls due to hyperawareness.
• Hypersomnolence. While you might seem to sleep fine at night, you still feel Fatigue during the day. You have a −(IE) penalty on saving throws against magic effects that induce sleep, and (IE)d4 times per day, you must succeed on a DC 8 + (IE) Constitution saving throw or become unconscious as if affected by the Sleep spell. (This condition could be ruled to cause characters of fey ancestry to need to sleep when they normally don’t.)
• Insomnia. You have trouble falling or staying asleep or both (equal chances of each). When beginning a long rest, you must succeed on a DC 8 + (IE) Constitution saving throw to fall asleep quickly. On failure, you lose the difference between your result and the number needed in hours of sleep and lose benefits of rest accordingly unless you sleep longer at the end of the long rest to compensate. If your form of insomnia wakes you while sleeping, determine the time you wake randomly by subtracting the loss from the total hours attempted, and roll 1d(difference) to determine how many hours you sleep before waking. If your insomnia is mixed, follow the above, but then roll to determine how many of the lost hours are at the beginning and how many happen after waking.
• Night Terrors. When you’re sleeping, you awaken at a random time during the rest and scream for (IE)d12 minutes. Each time this happens, you must succeed on a DC 5 + (IE) Constitution saving throw or have another screaming episode in 1d20 minutes, repeating until success. This will awaken anyone else sleeping near you who can hear and draw the attention of any nearby creatures. If awakened, you will be disoriented for (IE) rounds and have disadvantage on all Intelligence and Charisma checks.
• Nightmares. You experience frequent, vivid nightmares. Every time you sleep, you must succeed on a DC 15 + (IE) Constitution saving throw or have a nightmare 1d4 hours after falling asleep. The dream lasts 1d10 + 10 minutes. After the dream, you must succeed on another DC 15 + (IE) Constitution saving throw or have a nightmare 1d4 hours later, repeating the process until the end of the rest. Because of the trauma of these dreams, you experience (IE) Baseless Emotions for (IE)d6 × 10 minutes before a long rest and must succeed on a DC 10 + (IE) Wisdom saving throw to go back to sleep after the dream, repeating the saving throw every ten minutes on failure until successful.
• Sleep Aggression. You act violently while sleeping. Every time you sleep, you must succeed on a DC 15 + (IE) Constitution saving throw or begin attacking the closest creature with unarmed attacks 1d4 hours after falling asleep. The episode lasts until you take damage or succeed on a DC 10 + (IE) saving throw, which you can attempt each round. After the attack, you must succeed on another DC 15 + (IE) Constitution saving throw or attack again 1d4 hours later, repeating the process until the end of the rest. If your companions restrain you before sleeping, you must succeed on a DC 8 Constitution saving throw or experience Insomnia due to the discomfort of the restraint unless the method allows freedom of movement, such as a cage, and when the episode begins, you attempt to escape the restraint until the episode ends. With IE 1 Sleep Aggression, you remain prone and only attack anyone in bed with you or within your reach if you’re sleeping on the floor or a mat, but at a higher IE, you will get out of bed to attack.
• Sleep Behaviors. Every time you sleep, you must succeed on a DC 15 + (IE) Constitution saving throw or have a nightmare 1d4 hours after falling asleep. The dream lasts 1d10 + 10 minutes. During the nightmare, you act out the dream and perceive the creatures around you as the villains or monsters in your dream. You begin to twitch and moan, which escalates in 1d20 rounds to attacking if not awakened. On a successful DC 8 + (IE) Wisdom saving throw, you attack the nearest creature. On a failed saving throw, you are frightened and flee. You can be easily awakened by normal means or when you take damage. After the dream, you must succeed on another DC 15 + (IE) Constitution saving throw or have a nightmare 1d4 hours later, repeating the process until the end of the rest.
• Sleep Enuresis. You urinate while sleeping (IE)d4 times per week. Without support and understanding from allies, you must succeed on a DC 10 + (IE) Wisdom saving throw once per week or experience 1d4 Baseless Emotions until succeeding, making the saving throw once per day.
• Sleep Paralysis. When you awaken from sleep, you are paralyzed for (IE)d4 minutes. Because of the trauma of this experience, you must succeed on a DC 10 + (IE) Wisdom saving throw or experience (IE) Baseless Emotions for (IE)d6 × 10 minutes before a long rest.
• Sleep Sorcery. Every time you sleep, you must succeed on a DC 8 + (IE) Constitution saving throw or cast a random prepared spell at the lowest available spell slot 1d4 hours after falling asleep. After the casting, you must succeed on another DC 8 + (IE) Constitution saving throw or cast another spell 1d4 hours later, repeating the process until the end of the rest. If you do not have the necessary spell slot available or if you do not have the necessary focus or components within reach, the spell fails, and nothing happens. When the rest finishes, you will have used up spell slots for all spells successfully cast within four hours of the end of the rest.
• Sleep-Related Breathing Disruptions. You don’t get enough oxygen while sleeping, either due to apnea, chronic snoring, discharge, or failure to absorb enough. You experience IE 1 Fatigue, and every twenty-eight days, you must succeed on a DC 5 + (IE) Constitution saving throw or develop IE 1 Hypertension, the IE increasing on each failed periodic saving throw.
• Sleep-Related Hallucinations. When falling asleep or waking up (both equally likely), you experience Hallucinations.
• Sleep-Related Movements. You move excessively in your sleep, either random movements, leg Cramps, or teeth grinding, which keeps you from getting sufficient rest. At the end of every long rest, you must succeed on a DC 8 + (IE) Constitution saving throw or incur IE 1 Fatigue for the rest of the day.
• Sleep-Wake Disruption. Your internal sleep clock does not correspond to your intended pattern. If you cannot follow your internal pattern, follow the rules for Insomnia accordingly.
  

  d10	1d10 if you have IE 4 Blindness	Sleep-Wake Disruption
  1–4	1–3	Irregular Rhythm
  5–9	4–7	Delayed Phase
  10	8–10	Non-synchronized Circadian Rhythm

  • Irregular Rhythm. In order to achieve the benefits of a long rest, you must instead take (IE) short rests.
  • Delayed Phase. Your pattern of sleep begins (IE) × 3 hours before or after the time typical for your culture, and in order to gain the benefits of a long rest, you must begin your long rest within one hour of that time.
  • Non-synchronized Circadian Rhythm. Your internal sleep clock functions as if the day is (IE) hours longer or shorter (equal chances) than it actually is, which adjusts the time your body expects to take a long rest to a new time every day.
• Sleepwalking. Every time you sleep, you must succeed on a DC 15 + (IE) Constitution saving throw or have a dream 1d4 hours after falling asleep. The dream lasts 1d10 + 10 minutes. You act out your dream, walking, interacting with your environment, but with disadvantage on all Wisdom (Perception) checks. The GM should determine the nature of the nonviolent dream. If awoken while sleepwalking, you will be disoriented and have disadvantage on all Intelligence and Charisma checks for 1d10 rounds. An ally can make a DC 8 + (IE) Charisma (Persuasion) check to gently guide you back to bed on success.

Real-world Examples

Sleep Apnea, Sleep-related Hypoventilation Disorders, Sleep-related Hypoxemia Disorder, Kleine-Levin Syndrome, Delayed Sleep Phase Disorder, Sleep-wake Phase Disorder, Irregular Rhythm Sleep-wake Disorder, Non-24 Sleep-wake Disorder, Narcolepsy, Parkinson’s Disease, Lewy Body Dementia, Down Syndrome

Assistive Options

Most of these require patience and understanding by your allies most of all. If a party sets up a night watch, the person watching can also monitor you while you sleep and wake you if necessary when noticing behavior relating to disrupted sleep. Earplugs and a sleep mask or an otherwise dark and quiet environment can assist with sleep phase disruptions to allow for sleeping in sunlight and daytime activity.

Magical Assistance

A Sleep spell can help you get back to sleep when you can’t sleep, but it has no duration, so it won’t prevent waking or other traits that occur during sleep.