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The Sane Asylum

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Xorian creatures have captured one of the Twelve's informants and are holding him prisoner in an asylum here in the Embers District.

Reign of Madness adpack icon.jpg
DDO Point icon.png Requires access to adventure packIcon tooltip.png: Reign of Madness
The Sane Asylum
Heroic level: 17
Epic level: None
Duration: Long
Heroic XP:  ♣3,110Icon tooltip.pngSolo/Casual ♦5,386Icon tooltip.pngNormal ♥5,590Icon tooltip.pngHard ♠5,793Icon tooltip.pngElite
Epic XP: N/A
Takes place in: The Embers Asylum
Bestowed by: Horace Neble
NPC contact: Horace Neble
Quest acquired in: The Tower of the Twelve
Patron: The Twelve
Base favor: 7
Free to Play: No
Extreme Challenge: No
M sane asylum.png
Loading screen


According to Horace Neble, Xorian creatures are infiltrating the city of Stormreach. The Twelve had an informant spying on the creatures, but now the informant has been captured and is being held in an insane asylum in the Embers District.

You must find and free the informant. Travel to the Marketplace and then look for the Embers Asylum.

  • Note: The quest giver is found inside the Tower of The Twelve, but the quest itself is located on the far west edge of The Marketplace.

Spoiler Warning: Information below this point can be considered spoiler material!


  • Speak with Durk
  • Gain entry into the asylum
  • Find the source of madness
  • End the daydream
  • Confront the nightmare
  • Challenge the reality
  • Defeat Nurse Ratchet
  • (Optional) Find all the secret daydream passages — Bonus (9%): Heroic( ♣280 ♦485 ♥503 ♠521 )
  • (Optional) Defeat The Right Eye — Bonus (9%): Heroic( ♣280 ♦485 ♥503 ♠521 )
  • (Optional) Defeat The Wrong Eye — Bonus (9%): Heroic( ♣280 ♦485 ♥503 ♠521 )
  • (Optional)  — Bonus (38%): Heroic( ♣1,182 ♦2,047 ♥2,124 ♠2,201 )

What to Expect

  • Trap (fixed)
  • Collapsible floors
  • Puzzle (optional: semi-random tile puzzle)
  • Spawning/respawning monsters

Known Traps

Trap DC

  • One fire trap that can be disarmed or avoided

Tips and Misc

The three phases of the Asylum: Delirium, Nightmare, and Reality
The Sane Asylum puzzle
Puzzle 1 Point of view
Puzzle 2 Point of view
Solution Summary
One Puzzle: 1, Solution
  • The quest entrance is located on the far western edge of The Marketplace, west of the Phoenix Tavern
  • Altar of Insanity: This quest drops Brain Sample and Watcher's Eye.
  • There are two ways to reach inside of the asylum - the side door involves less combat but passes a trap.
  • The central "square" of the map (that has the three drop points) is a bit of a maze which changes layout as you kill the nightmare, reality, and daydream (in that order).
    • Excellent maps of the maze, with walkthrough and puzzle solution, here.
  • There are two ways to free Fred (Yep, our beloved feat respec NPC) - either solve the puzzle or kill two beholders ('Right Eye' and 'Wrong Eye').
  • Once the puzzle is solved, the beholders disappear (unless they have been attacked before solving the puzzle).
  • Once the beholders are killed, the puzzle disappears.
  • Thus if you want to get all the chests:
  1. Attack a beholder until he switches to the other type, so both are in your objectives list.
  2. Leave via the waypoint during the fight.
  3. Complete the puzzle.
  4. Head back, slay Nightmare again (respawns), which opens the way to the beholders again. Kill them before engaging the end boss.
  • The beholders can be accessed by entering tunnels that are revealed by dropping floors when entering two of the cells after killing nightmare but before killing reality.
  • Puzzle solutions:
    • There are two possible puzzle variants. You can easily identify them by looking at the tile east of Fred (see pictures; the tile pattern will be either a straight line or at a right angle). For example image 'Puzzle 1 Point of view' shows the right angle patterned tile by Fred, whereas the image 'Puzzle 2 Point of view', shows the straight line pattern tile. Multiple solutions have been reported.
    • Solving the puzzle is required to get the Sustaining Symbiont. After solving the puzzle, ask Fred for a reward in order to get the chest, e.g. choose the dialogue option: "You're really bad at praising, Fred. Maybe you should try rewarding, instead."
  • Nurse Ratchet's special attack does more damage as her health drops (DDO Forums).
  • Nurse Ratchet self-heals. Bring enough DPS.
  • On elite the orderlies have many forms of crowd control, including mind blast, dominate, dancing ball and hold. Buff appropriately.
  • Once Nurse Ratchet is dead, the party is teleported to the asylum reception and the asylum is locked.
  • When grinding the quest for either the Shard of Xoriat or the Sustaining Symbiont, do NOT speak to Durk. You can get to both chests without actually completing this objective. Once you have looted the chests, simply recall out and reset the instance.
  • Speed run: Talk to Durk. Take the trapped path, invisible. Kill Receptionist. Go to the NW corner, kill Nightmare. Go to the SW corner, kill Reality. Go to the NE corner, kill Daydream. Go north, solve puzzle, and complete quest.
    • Trivia: Nurse Ratchet is most likely a reference to Nurse Ratched, the sadistic nurse from the novel and movie One Flew Over the Cuckoo's Nest.
    • Trivia: Durk says (Say): Durk the Deranged says, 'Don't let the Sane Asylum sneak up on you. It's worse than a gazebo, it is.' This is a (yet another) reference to the Deadly Gazebo.

Bonus XP


  • Chests: Up to 4. All can be had in a single run if done correctly.
    • One by the optional daydream tunnel shrines
    • One for solving the puzzle and asking Fred for a reward (may have Sustaining Symbiont)
    • One (appears a little down the corridor from Fred) for killing Right and Wrong Eye
    • One for completing (may have Shard of Xoriat)
  • Collectables: None
  • NPC rewards: Standard

Named Chest Drop


Name(picture) CR Type Race
Nurse Ratchet(view)
Nurse Ratchet.png
 ♦20Icon tooltip.pngNormal ♥24Icon tooltip.pngHard ♠30Icon tooltip.pngElite Aberration Beholder
The Right Eye(view)
The Right Eye.png
 ♦20Icon tooltip.pngNormal ♥24Icon tooltip.pngHard ♠30Icon tooltip.pngElite Aberration Beholder
The Wrong Eye(view)
The Wrong Eye.png
 ♦20Icon tooltip.pngNormal ♥24Icon tooltip.pngHard ♠30Icon tooltip.pngElite Aberration Beholder
 ♦18Icon tooltip.pngNormal ♠26Icon tooltip.pngElite Evil Outsider Demon
Evil Eye(view)
Evil Eye.png
 ♦12Icon tooltip.pngNormal ♠17Icon tooltip.pngElite Aberration Evil Eye
Eye Horror(view)
Eye Horror.png
 ♠21Icon tooltip.pngElite Aberration Eye Horror
Greater Evil Eye(view)
Greater Evil Eye.png
 ♥17Icon tooltip.pngHard ♠21Icon tooltip.pngElite Aberration Evil Eye
Male Patient(view)
Male Patient.png
 ♦17Icon tooltip.pngNormal ♠25Icon tooltip.pngElite Humanoid Human
Night Shift Orderly(view)
Night Shift Orderly.png
 ♦18Icon tooltip.pngNormal ♠26Icon tooltip.pngElite Aberration Mind Flayer
Nightmare (Fire Reaver)(view)
 ♦18Icon tooltip.pngNormal ♠26Icon tooltip.pngElite Evil Outsider Demon
Odd Stormreach Citizen(view)
Odd Stormreach Citizen.png
 ♦17Icon tooltip.pngNormal ♠25Icon tooltip.pngElite Humanoid Human
 ♦18Icon tooltip.pngNormal ♠26Icon tooltip.pngElite Evil Outsider Demon
Shady Character(view)
Shady Character.png
 ♠25Icon tooltip.pngElite Dwarf Dwarf
Suspicious Stormreach Guard(view)
Suspicious Stormreach Guard.png
 ♦17Icon tooltip.pngNormal ♠25Icon tooltip.pngElite Humanoid Human
The Receptionist(view)
The Receptionist.png
 ♦18Icon tooltip.pngNormal ♠26Icon tooltip.pngElite Orc Orc

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