Beneficial drugs (stimpacks, rad X, radaway) can be dehydrating, induce hunger, and leave you vulnerable to sicknesses. One such complication requires more sleep another is an infection that causes periodic damage. Diseases can be contracted that have different effects. Eventually, you suffer periodic damage which will cause death. The need to drink, eat, and sleep regularly, lest stats be diminished and fatigue set in. Fatigue from associated health concerns reduces AP, meaning less sprinting time and VATS. Much slower healing from stimpacks, food, and water. More damage from opponents death occurs after a few hits. What's Different in Fallout 4's Survival Mode: 
Things are generally bleaker and more unforgiving, and every enemy's lethality is significantly higher. Survival difficulty replaces the normal Fallout experience with something significantly more nightmarish.
Unless you've been living under a rock, blind-folded, with your fingers in your ears, you've probably heard about Survival difficulty in Fallout 4.
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