Try to eliminate any unnecessary background processes during play.

The most common reason for this is the game is running over its required 60hz, the game is hardcoded to run at 60hz and this cannot be changed. To solve this, set your monitor's refresh rate to 60hz. You can always check on the game's monitor check if the game is fluctuating around 59.94hz, the NTSC standard. If it's not around there and your monitor is indeed set to 60hz, consider trying a different panel or forcing vsync on in your GPU's graphics settings.

Some monitors and display adapters may not support the odd resolution the game runs at, which is 1360x768 versus the occasionally seen 1366x768. To resolve, setup a custom resolution inside your appropriate graphics card settings, or enable GPU resolution scaling.

This game may fail in the case of using HDMI audio. Even if you're not using HDMI audio however, some failures to boot have been noted. Please update to the latest SpiceTools which fixes this issue.