Shift-by-shift breakdown of what unlocks, what to expect, and how to survive from your first night to endless survival.
Each completed shift unlocks new content: more patients, new detection layers, harder events, and additional enemies. The game teaches you its mechanics one layer at a time. Mastering each layer before the next one unlocks is the intended learning curve.
After Shift 6, the game enters endless survival mode. No new content unlocks — instead, difficulty scales infinitely: more anomalies per shift, faster events, higher sanity drain, and increased enemy aggression. How long can your team last?
Tutorial — learn the layout and basic mechanics without pressure.
Focus entirely on learning the patient roster and the treatment flow. Ignore anomaly hunting until you can treat normal patients from memory.
Easy — one new event type and a second detection layer, but still forgiving.
Start running the 2-layer check (visual + photo) on every patient. Buy Coffee if it appears in the shop — you will need it soon.
Moderate — CCTV layer adds a whole new workflow, and Skinwalkers punish overconfidence.
Start using the full 4-layer check (visual → photo → CCTV → document) on every patient. Buy the Gun as soon as possible — Skinwalkers kill fast.
Hard — multiple overlapping events can trigger. Sanity management becomes critical.
Consider switching to Psychologist if sanity is becoming a problem. Coordinate with teammates — one person on ambulance, one on admissions.
Very Hard — full threat roster active. One mistake cascades into multiple failures.
Surgeon is worth the cash investment. Keep coffee on you at all times. Run the 4-layer check on autopilot — no exceptions, no skipped steps.
Extreme — generally considered the highest shift most players can reliably solo.
If you can clear Shift 6 solo, you have mastered the game. Two anomalies at the window simultaneously is the hardest spike — check each independently against all 4 layers.
Endless — designed for coordinated team play. Difficulty scales infinitely.
Multiplayer is strongly recommended. Dedicate roles: one player on CCTV, one on admissions, one on roaming threats, one on treatment. Psychologist class passive is nearly mandatory for sanity management.
| Shift | Visual | Photo | CCTV | Skinwalker | Layers to check |
|---|---|---|---|---|---|
| Shift 1 | Active | — | — | — | 1-layer check |
| Shift 2 | Active | Active | — | — | 2-layer check |
| Shift 3 | Active | Active | Active | Active | 4-layer check |
| Shift 4 | Active | Active | Active | Active | 4-layer check |
| Shift 5 | Active | Active | Active | Active | 4-layer check |
| Shift 6 | Active | Active | Active | Active | 4-layer check |
| Shift 7+ | Active | Active | Active | Active | 4-layer check |
The main game covers 7+ shifts. Shifts 1-6 are a structured progression with escalating difficulty — each shift introduces new anomalies, enemies, and events. Shift 7 and beyond is endless survival mode where all threats are active simultaneously and difficulty increases continuously until you fail.
Yes, each server supports up to 30 players. Coordinating with teammates — one person on CCTV monitoring, one on admission window checking patients, one on treatment, one on event response — makes higher shifts dramatically more manageable. Shift 7+ solo is extremely difficult; team play is the intended experience.
Shift 6 is the generally accepted solo limit for most experienced players — it requires near-perfect anomaly detection, event response, and sanity management. Shift 7 (endless survival) is designed for teams of 3+ and becomes exponentially harder for solo players. If you want the challenge, push solo as far as you can, but expect to fail eventually.
Yes. Items purchased from the shop (Coffee, Gun, Taser, etc.) persist across shifts permanently. Your class selection carries forward between shifts until you choose to switch. Cash carries over, letting you save for expensive items and class unlocks over multiple shifts.
Failing a shift (sanity reaching zero, dying to an enemy, or losing all patients to events) ends the current run. You keep all purchased items and unlocked classes, but you must restart from Shift 1 or the last checkpoint. The game is designed around incremental progress — each failed run teaches you something for the next attempt.
The story has two possible endings determined by your interactions with Barney across the structured shifts (1-6). After the story concludes, Shift 7+ is endless survival with no final ending — it is a score-chasing mode where the goal is surviving as long as possible with increasingly overwhelming threats.
