This page covers a healer-focused strategy for Carapace of N'zoth in Ny'alotha, the Waking City. While it's tailored for healers, other roles may also find the information useful. If you have any suggestions or feedback, you can leave a comment below or tweet @PrestonDvorak.

This guide has been updated and maintained based on my own experiences with the encounter, log information, and Dungeon Journal information. I'll continue to update it as-needed.

General Mechanics and Abilities

Normal and Heroic

All Stages

• Players must keep their Sanity above 0 for as long as possible.
  • Sanity is tracked with the Alternate Player Power Bar UI element, just like in Horrific Visions.
  • This is made easier in the earlier stages with Wrathion's aid (detailed below).
  • Players that reach 0 gain Gift of N'zoth, dealing increased damage and healing for 20-seconds.
    • When the effect expires, the player becomes a Servant of N'zoth.
      • The player is Charmed and can be killed.
      • Interrupt Mental Decay to prevent the Sanity drain and light damage over time on other players.

Stage One - Exterior Carapace

This stage begins the encounter and ends when Fury of N'zoth reaches 50% health.

• Wrathion is active during this stage.
  • Standing in his Anchor of Sanity restores Sanity.
  • Increases movement speed after leaving the Anchor with Grave of the Black Prince.
  • Grants players the Extra Action Button ability Ashjra'kamas, Shroud of Resolve. On use, this heals for 100% health, grants immunity to Sanity loss, and teleports the player to Wrathion.
• Fury of N'zoth
  • The tanks will be dealing with Mandible Slam, which applies stacks of Black Scar and will force a tank switch.
  • When affected by Madness Bomb, move at least 10-yards away from other players.
  • Targets random players with Mental Decay, removing 5 Sanity (15 on Heroic) and dealing light damage over time.
  • Applies Adaptive Membrane to random enemies, causing them to absorb damage and be immune to crowd control effects and interrupts while active.
    • If the entire absorption amount is damaged through before it expires, the absorbed amount is dealt as damage to the affected enemy.
      • Additionally, a Fragment of Sanity is spawned, restoring 10 Sanity to a player that runs over it.
• Avoid the impact location of Growth-Covered Tentacle.
  • Avoid the subsequent impact locations that spawn Nightmare Antigens.
    
    • Nightmare Antigen
      • Players hit gain stacks of Nightmare Antibody, reducing haste and movement speed.
      • Periodically gains a stack of Adaptive Antigen, increasing damage dealt.
  • All Horrific Hemorrhages on the Tentacle must be killed to prevent them from bursting and dealing critical damage to all players.
    • Once all are killed, Interconnectedness deals damage to Fury of N'zoth.
• On Heroic, Gaze of Madness
  • When targeted by Breed Madness, use a personal defensive cooldown if an interrupt isn't available.
    • Deals moderate damage to all players when interrupted or when the channel finishes with Maddening Eruption, draining 5 Sanity.
      • Applies a stack of Deepening Madness, increasing damage taken by subsequent Maddening Eruptions.
  • When killed, Interconnectedness deals damage to Fury of N'zoth.

Stage Two - Subcutaneous Tunnel

This stage begins when Fury of N'zoth reaches 50% health and ends when it reaches 40% health.

• Wrathion is active during this stage.
• Fury of N'zoth
  • Madness Bomb, Mental Decay, Adaptive Membrane, and Mandible Slam continue during this stage.
  • Deals moderate damage to all players with Eternal Darkness, draining 10 Sanity.
  • Don't stand in front of the boss when Occipital Blast is cast to avoid the frontal cone.
• On either side of the room are long paths that contain the following:
  • Mycelial Cyst
    • Slowly regenerates health with Regenerative Mass.
    • Coats the ground in Mycelial Growth, dealing light damage over time and slowing movement speed of players standing in it.
      • The coverage area is reduced as the Cyst loses health.
    • The Fury of N'zoth gains Mycelial Infusion while standing in Mycelial Growth, granting an increased damage dealt buff.
  • Synthesis Growth
    • Each Growth grants Fury of N'zoth Synthesis, healing over time and absorbing all damage taken.

Stage Three - Locus of Infinite Truth

This stage begins when N'zoth reaches 40% health and ends when it's killed.

• Wrathion is no longer active during this stage.
• Fury of N'zoth
  • Mental Decay, Adaptive Membrane, Mandible Slam, and Eternal Darkness continue during this stage.
    • On Heroic, Eternal Darkness becomes Infinite Darkness and now deals heavy damage to all players, draining 10 Sanity.
      • Avoid the Infinite Void zones left behind.
  • When affected by Insanity Bomb, move at least 10-yards away from other players.
    • Upon expiring, spawns a Nightmare Antigen which functions the same as in stage one.
• Avoid the impact location of Thrashing Tentacles.

Mythic Differences

All Stages

• Players can now be targeted by Adaptive Membrane, which reduces healing received in addition to the prior effects.
  • Leaves behind a Shard of Insanity that restores Sanity to all players within 20-yards.

Stage Two - Subcutaneous Tunnel

• Wrathion is no longer active during this stage.
• The stage now ends when all Synthesis Growths are killed.
• Mycelial Cyst
  • No longer affected by Regenerative Mass. 
  • When killed, gains Reactive Mass, becoming untargetable and healing to 100% health when the effect expires.
    • Additionally, when the effect expires, be at least 15-yards away from the Cyst to avoid Regenerative Expulsion.
• Synthesis Growth
  • Now spawn two Nightmare Antigens when killed.

Stage Three - Locus of Infinite Truth

• Mycelial Cyst are now present in this stage, functioning the same as above.

Healing Notes

Quick Notes, All Difficulties

The notes below mostly pertain to progression difficulty, meaning if you out-gear the difficulty you're on or use extra healers they may not apply.

• Use Major Cooldowns on
  
  • Infinite Darkness
• Use Minor Cooldowns on
  
  • Eternal Darkness
  • Maddening Eruption, especially if Deepening Madness stacks are higher
• Pre-heal Before (mainly for heal over time classes)
  • Eternal Darkness
  • Infinite Darkness
  • Maddening Eruption
• Potion of Replenishment use
  • during stage two, after an Eternal Darkness
  • or, at the beginning of stage three, before Sanity loss becomes an issue
• Other things to watch for
  • Keep a close eye on your Sanity, as you don't want to reach 0 before stage three, if at all.
  • Tanks with Black Scar may need an external defensive cooldown if a tank switch can't happen.

Debuffs to Track

Major

• Black Scar causes the tank to take additional damage from subsequent attacks.
• Adaptive Membrane causes players to be immune to damage and take reduced healing.
• Breed Madness causes the affected player to take critical damage over time.

Minor

• Several abilities cause players to need additional healing.
  • Insanity Bomb
  • Madness Bomb
  • Mental Decay

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 DBM Settings

Below are the DBM settings I'll be using for Carapace of N'zoth. You can set them up however you'd like, but these ones should work well as a starting point. Some settings may be Mythic only.

Healer DBM Settings for Carapace of N'zoth

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