Azathoth's Dream is the only known Realm not created by the High God. This Realm was created by the dreaming of the sleeping Empty God Azathoth after he was imprisoned. It is a parallel of Earth Realm, although the Empty Gods have a stronger presence here, leading to much distress for the inhabitants. The humans and other creatures that inhabit this Realm do not travel to the Astral Plane when they die, and if Azathoth is to ever awaken they will cease to exist.

This Realm is notable as it is based on the world as presented in the works of H.P. Lovecraft, and his Cthulhu Mythos.