It is a horror game drawing inspiration from the lead designer Matt Gilgenbach's personal struggles with obsessive–compulsive disorder and depression;[2] in an interview, he stated that he was "trying to create that feeling [of bleakness and hopelessness] in Neverending Nightmares".

[citation needed] The game features a 2D hand-drawn line art style heavily influenced by the works of Edward Gorey.

[4] It uses a minimalist user interface, forgoing onscreen prompts and loading screens during play in order to increase immersion.

As he wanders through each nightmare, "waking up" in a bed each time, the player sees Thomas commit gruesome acts of self-harm out of depression, such as pulling a blood vessel or even a bone out of his arm.

[13] Smangaliso Simelane praised the game's "spooky soundtrack composed of twinkling piano notes and ominous synthetic whines.

[15][16] In a positive review, GameRevolution praised the story and atmosphere, recommending, "Whether or not you find it scary, you’ll definitely be disturbed and intrigued.

[18] Similarly, Justin Clark of GameSpot commended the game's atmosphere and art style, but criticized the gameplay, endings, and replay value.