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Each rank of the Adrenaline perk provides a +5% bonus to one's damage output, for a maximum of +50%, balancing out the fact that Survival difficulty makes combat significantly more lethal. The bonus to damage increases with the more kills one obtains (from hostile targets or otherwise), and appears to increase by one rank for every five kills. However, sleeping causes accumulated ranks of Adrenaline to subside at a rate of one rank per hour slept.
- Fallout 4 loading screen hints: "In Survival, Adrenaline provides a bonus to your damage output. The higher your Adrenaline, the higher the damage bonus. Sleeping for any amount of time will lower your Adrenaline, taking your damage bonus down with it."