The aim of Atmosfear is to collect a key from each of the six regions of the board before heading to the "Well of Fears" in the centre and attempting to draw your fear from among those of your opponents in order to win the game. This must be done before the clock counts down to zero, or all players lose automatically.

Like all previous games in the Nightmare/Atmosfear series, Atmosfear makes for stressful play. Players rush to take their turn and pass on the dice as quickly as possible before the Gatekeeper appears and calls on them, and are encouraged to work competitively against each other.

Atmosfear 2019 uses an App - for apple and android devices - which acts as a timer, constantly ticking away toward the end of the game. It is also a channel for The Gatekeeper, who frequently appears on screen and causes problems for any or all of the players. As in the previous DVD version, the Gatekeeper’s appearances are randomised so you cannot predict when he will turn up next or what he’ll say. But unlike its predecessor, the game length is also randomised, varying between about 40 and 50 minutes. Where there was only one screen in all the previous versions, the App can run on multiple devices, so the Gatekeeper can sometimes pop on a player’s own personal phone.