The damage Eileen takes in the game determines whether or not she dies during the final boss fight, directly affecting the ending achieved. Eileen cannot die while she is with Henry, although as she takes damage she succumbs to possession, which also occurs if she is given a firearm. In the second half of the game Henry is accompanied and helped in combat by his neighbor Eileen Galvin. Unlike previous games in the series, separate difficulty settings for combat and puzzles are not available changing the combat difficulty also affects the difficulty of puzzles. Silent Hill 4 emphasizes combat during gameplay, with a near-absence of complex puzzles in favor of simple item-seeking tasks. The player has a limited item inventory which can be managed by leaving unneeded items in a chest in Henry's room. In the main levels of the game the player uses the usual third-person view of the Silent Hill series. For the first half of the game, the room restores Henry's ' health' (a measure of the amount of damage that he can endure before 'dying') in the second half of the game, however, the room becomes possessed by hauntings that drain his health.

The other areas of the game are reached through holes formed in the apartment. Gameplay centers on the apartment, which is shown through a first-person perspective and contains the only save point. The objective of Silent Hill 4: The Room is to guide player character Henry Townshend as he seeks to escape from his apartment. Upon its release, the game received generally favorable critical reaction, but its departure from the typical features of the series received a range of reactions. Silent Hill 4 features an altered gameplay style with third-person navigation and plot elements taken from previous installments. During the course of the game, Henry explores a series of supernatural worlds and finds himself in conflict with an undead serial killer named Walter Sullivan. Unlike the previous installments, which were set primarily in the town of Silent Hill, this game is set in the southern part of the fictional city of Ashfield, and follows Henry Townshend as he attempts to escape from his locked-down apartment. On October 2, 2020, it was re-released on GOG.com with patches to make it playable on Windows 10. In 2012, it was released on the Japanese PlayStation Network. Its soundtrack was released at the same time. Silent Hill 4 was released for the PlayStation 2, Xbox, and Microsoft Windows.

The fourth installment in the Silent Hill series, the game was released in Japan in June and in North America and Europe in September. Silent Hill 4: The Room is a 2004 survival horror game developed by Team Silent, a group in Konami Computer Entertainment Tokyo, and published by Konami.

Silent hill 2 coin puzzle