We are reluctant to intrude in a discussion in this case report. Based on their clinical observations of the patient (an 84-yearold woman with long-standing history of excessive daytime sleepiness (EDS), the study authors’ most likely diagnosis was late onset narcolepsy. However, we believe that some of the inferences made by Carlucci and Prasad (1) merit further comments. We see this as an interesting and important case report and professionally reported. However, we view the number of atypical symptoms and their significance from a perspective that is somewhat different from those of the authors. We believe that there are several fundamental questions that need to be addressed here. In areas where we do not agree with the authors, we have stated them with the rationale for our disagreement. We address our comments point by point as follows: The patient was reported to be morbidly obese (BMI = 36), and to have a large neck circumference (NC = 17), and a Mallampatti Gr III airway. Nevertheless the patient had a normal AHI which was just 0.9 with normal overnight oximetry. Further, the overnight hypnogram reveals that most, if not all, apneas are rapid eye movement (REM)-related, but not positional. Although not impossible, the inference that the apneas were almost exclusively a REM sleep phenomenon appears improbable. The first question is – was the observed low AHI related to the poor quality of sleep on the testing nights (sleep efficiency 64 and 71%). Second, this lady was not described having any other symptoms that had supported the diagnosis of narcolepsy viz., hypnagogic or hypnopompic hallucination. If they were present, their presence should be considered in presence of poor quality sleep in night, as recorded by two overnight polysomnograms. Third, the patient was described as excessively sleepy (ESS score: 11/24). The cut-off ESS score is an arbitrary one and based upon the population norm. Our concern is can a patient be categorized as excessively sleepy because she scored just 1 point more than the population norm, i.e., 10. We think, an important issue to consider is the compromise in daytime functioning because of sleepiness, especially when we are dealing with a single case. Moreover, the authors state that at the time of the study she was on multiple medicines including cyclobenzaprine, and hydrocodone, which were taken as needed. Hydrocodone and cyclobenzaprine both can produce drowsiness. Hence, ingestion of these medications should also have been taken into consideration while inferring the information about EDS. The report mentions that patient had goiter. The question is, whether the thyroid profile was within normal limits? Moreover, was the toxicology screening done to find out the reason for excessive daytime sleepiness? Fourth, was the quality and duration of nighttime sleep sufficient to justify performing an MSLT? (2). The inadequate sleep that the patient had the night before could also have resulted in daytime sleepiness and SOREMPs (3). Fifth, as per self-reports of the patient, the authors mentioned that she maintained a regular schedule (although no mention was made with regards to her usual bed time). Considering her age, is it possible that her habitual time of retiring was much earlier than the sleep time followed in laboratory (11:02 p.m. as per the study record); this could have produced an early onset of REM during the overnight polysomnogram. Sixth, as per the hypnogram, the patient had long period of self-awakenings from all of her REM periods. The interesting question is – would this have produced early REMs in her MSLT, especially during first MSLT session during the subsequent daytime study? For example, REM sleep onset latency (REMOL) in the first REM period in the MSLT was markedly reduced (3 min) while subsequent MSLT tests showed somewhat delayed REMOL. Another possibility when we see this data in association with poor sleep efficiency is that the patient might have been almost, if not already sleeping during the hookup of the first MSLT. Only a clear video recording review would prove this. It should be considered also that severe or complex psychiatric, neurological, or medical disorders, and the use of anticataplectic or stimulants can compromise the validity of the MSLT. In addition, sleep latency on MSLT and number of SOREMPs usually decreases as a function of age (4).