Sanity Gain And Loss

A character regains Sanity in the Dreamlands at the normal Call of Cthulhu rate for defeating monsters or enemies. The means of losing Sanity are the same as in the Waking World, but the effects of Sanity loss are not.
If a character loses more than five points of Sanity in a single encounter and also fails an Idea roll, one Nightmare Effects Table is suffered. These nightmares replace both temporary and indefinite insanity. A character who loses all his Sanity is permanently transformed into the most appropriate horror the keeper can think of. For instance, a person who associated with ghouls might be transformed into a ghoul. The earthly body of such an unfortunate goes permanently insane or dies in its sleep.