You are nearly always tired. After every long rest, you must succeed on a DC 8 + (IE) Constitution saving throw, or you do not benefit from the rest, regardless of the amount of rest you get. Spending an entire day resting will automatically give you advantage on the Constitution saving throw.

Real-world Examples

Chronic Fatigue Syndrome, Lyme Disease, Fibromyalgia, Lupus, Hypothyroidism, Multiple Sclerosis, Insomnia, Postural Orthostatic Tachycardia Syndrome

Assistive Options

Beginning a long rest three days in a row at roughly the same time grants a +1 bonus to the Constitution saving throws, keeping the pattern adding an additional +1 bonus cumulatively to a maximum of +5. Keeping a diet for at least seven days of fish, vegetables, and nuts gives a +1 bonus to the Constitution saving throw. Drinking more alcohol than (Constitution Bonus) drinks will negate this bonus. A weighted blanket during a short rest also gives a +1 bonus to the Constitution saving throw. Such a blanket can be made from two large animal pelts for a medium humanoid or two medium animal pelts for a small humanoid plus enough sand to make the total weight 10 percent of your body weight. The cost of fabrication is 20 gp.

Magical Assistance

If the fatigue is caused by Insomnia, a Sleep spell or other effect that mimics it will assist in getting to sleep during a long rest and will reduce the IE by 1 Extent until the next long rest.

Some of your face is paralyzed (20 percent × IE), making it difficult to talk and use non-verbal communication with your face. You receive a penalty on Charisma (Performance) and Charisma (Persuasion) checks equal to the IE. This is typically permanent, but the player and GM could choose a magical cause that results in fluctuations.

Real-world Examples

Bell’s Palsy, Lyme Disease, Injury, Multiple Sclerosis, Ramsay-Hunt Syndrome, Guillain-Barré Syndrome, Moebius Syndrome, Melkersson-Rosenthal Syndrome, Stroke

Assistive Options

Because facial paralysis usually prevents the eye from blinking fully, you must use eye drops to keep the eye moist and likely need to monitor for drooling and keep a towel handy.