Reconsidering Wakefulness-Centered Treatment in Narcolepsy — The Neglect of Nocturnal Sleep Disturbance and the Fallacy of "Equivalent Total Sleep Time" —

Treatment and research in narcolepsy have long prioritized the improvement of daytime wakefulness. As a result, therapeutic frameworks centered on wake-promoting agents have become dominant, while nocturnal sleep disturbance has been treated as a secondary or background issue. However, existing evidence, including nocturnal polysomnography (PSG), consistently demonstrates that nighttime sleep in narcolepsy is intrinsically unstable and fragmented.This paper organizes the structural factors that have led to an excessive emphasis on wakefulness and examines how the logic that “total sleep time is equivalent or largely preserved compared to healthy individuals” has obscured impairments in sleep quality and limited therapeutic perspectives. Furthermore, we re-evaluate evidence that targeting nocturnal sleep can improve daytime symptoms, as exemplified by sodium oxybate, and argue that future treatment research should position nighttime sleep as a primary therapeutic arena.