Year of the Dragon: Through June 26th, claim free Ground Bound Green Dragon Mount! Speak to Xatheral in the Hall of Heroes. edit

Game mechanicsNewbie guideIn developmentDDO StoreSocial Media

ChallengesClassesCollectablesCraftingEnhancementsEpic DestiniesFavorFeats


Please create an account or log in to remove ads, build a reputation, and unlock more editing privileges and then visit DDO wiki's IRC Chat/Discord if you need any help!

The Sane Asylum

From DDO wiki
Jump to navigation Jump to search
The Sane Asylum is the 2nd quest in the Reign of Madness story arcIcon tooltip.pngStory arcs  are chains of quests that make up a story line.
Completing everything in a story arc often yields a nice reward.
The first three quests can be completed in any order to unlock The Lord of Eyes.
Acute Delirium • The Sane Asylum • The Lord of Stone • The Lord of Eyes

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 pack: Reign of Madness
The Sane Asylum
Heroic level: 17
Epic level: None
Duration: Long
Heroic XP:  ♣3,110Solo/Casual ♦5,386Normal ♥5,590Hard ♠5,793Elite
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
Purchase: Reign of Madness or VIP
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.

Spoiler Warning: Spoiler material below this point!


  • 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 (12%): Heroic( ♣373 ♦646 ♥671 ♠695 )
  • (Optional) Defeat The Right Eye — Bonus (12%): Heroic( ♣373 ♦646 ♥671 ♠695 )
  • (Optional) Defeat The Wrong Eye — Bonus (12%): Heroic( ♣373 ♦646 ♥671 ♠695 )
  • (Optional) Free the Mind Flayer by unraveling its prison — Bonus (50%): Heroic( ♣1,555 ♦2,693 ♥2,795 ♠2,897 )

What to Expect

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

Known Traps

Trap DCs

  • 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
  • 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).
  • 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 beholders are killed, the puzzle disappears.
  • The beholders no longer disappear once the puzzle is solved.
    • To get all the chests, solve the puzzle first and kill the beholders after.
  • 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 for a chance 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 North-west corner, kill Nightmare. Go to the South-west corner, kill Reality. Go to the North-east corner, kill Daydream. Go north, solve puzzle, kill Nurse Ratchet and complete quest.


  • Nurse Ratchet is most likely a reference to Nurse Ratched, the sadistic nurse from the novel and film One Flew Over the Cuckoo's Nest.
  • 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

  • Aggression bonus: 43 or more monsters killed +10% Bonus.( ♣311 ♦539 ♥559 ♠579 )
  • Onslaught bonus: 56 or more monsters killed +15% Bonus.( ♣467 ♦808 ♥839 ♠869 )
  • Conquest bonus: 68 or more monsters killed +25% Bonus.( ♣778 ♦1,347 ♥1,398 ♠1,448 )

External Links


  • Chests: 3 or 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 contain Sustaining Symbiont)
    • One (appears a little down the corridor from Fred) for killing Right and Wrong Eye
    • One for completing (may contain Shard of Xoriat)

NPC end rewards

Randomly generated loot, ML correlates with effective quest level.

Named Chest Drop

Last Edited Item Type Enhancements ML Bind Quests
  • Update 48.2
  • 3 years and 6 months
  • BugTime
Sustaining Symbiont
Sustaining Symbiont.png
  • Greater False LifeIcon tooltip.pngGreater False Life: This item grants the wearer +30 maximum health.
  • Suppress MadnessIcon tooltip.pngSuppress Madness: This strange creature is enchanted with the ability to temporarily filter the maddening effects of certain Xoriat items. Wearing it will suppress the effects of the following: Curse Vector, Unwieldy, Overfocus, Mind Turbulence, Symbiotic Backlash, Metal Fatigue, Power Drain, and Single-Mindedness.
  • Exceptional Constitution +1Icon tooltip.pngExceptional Constitution +1: This item gives the wearer improved health, granting a +1 exceptional bonus to Constitution.
  • Exceptional Fortification (+10%)Icon tooltip.pngExceptional Fortification (+10%): This item produces a magical force that protects vital areas of the wearer more effectively. When a critical hit or sneak attack is scored on the wearer, there is a +10% chance that the critical hit or sneak attack is negated and the damage is instead rolled normally. This ability is considered an Insight bonus when determining stacking with other sources of fortification
15 Bound to Account on AcquireIcon tooltip.pngBound to Account on Acquire: This item is Bound to Account on Acquire The Sane Asylum, Fred's chest
Shard of Xoriat
Shard of Xoriat.png
Trinket  15 Bound to Account on AcquireIcon tooltip.pngBound to Account on Acquire: This item is Bound to Account on Acquire The Sane Asylum, end chest
⇑   ⇑   Back to top   ⇑   ⇑


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