The game is centered on using a variety of items in a time period of only five days to escape the house whilst avoiding the only active stalking threat.^[3] The player can either escape by removing the locks on the front door, or by repairing the car in the garage, the latter of which requires an additional set of items.^[4] There a total of 16 items that are necessary to collect in order to escape.^[5]

Granny searches the house for the player, using any loud sound to her advantage and setting traps to hinder the player's progress. If Granny spots the player, she will start chasing them.^[6] There is also a giant spider on the top attic floor, which guards an important item and will attack the player on sight if it is not distracted or killed, but cannot move around the house freely. The player also receives injuries during the period of time they are in the house which includes limping and blood surrounding the peripheral vision.

If the player is caught, Granny will knock the player unconscious, which ends the current day. The player can also get knocked out by several other environmental hazards found throughout the game. If the player is caught on the last day, one of 4 "game over" cut-scenes play, and the player is sent back to the title screen. The player can knock Granny unconscious, or blind her temporarily by using a variety of different traps and weapons.

An additional 'nightmare mode' adds a bloodier texture to surfaces and re-textures Granny's model, as well as re-skinning Granny's bear traps.