There's this ghostly piano that keeps folding in on itself throughout Tsukikage no Simulacre's soundtrack. The score for this 2017 Windows visual novel builds atmosphere with these sparse, tense compositions that never let you feel safe.
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トオイヤクソク starts gentle enough but something underneath keeps pulling at you, and then they strip the percussion out for a variant that's even more unsettling. カラクリノイエ has this mechanical quality, like music box gears grinding slowly.
The character themes blur together in the best way. ジユウノハネ's piano arrangement at the end hits different after sitting through all that tension. If you like VNs that use silence as much as sound, this one gets it right.