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Medication reminders are the one notification category the user has explicitly opted in to. iOS 15+ supports `aps.interruption-level: time-sensitive` to break through Focus modes per category, gated on a per-app toggle the user grants on install. Wire it for MEDICATION_REMINDER only — every other event (mood nudges, anomaly alerts, PRs, system messages) stays on the iOS default `active` level so Focus modes including Sleep keep silencing them as the user expects. Pairs with `apns-priority: 10` for time-sensitive deliveries per Apple's push best-practices doc; without the priority pairing APNs may downgrade delivery and silently lose the Focus-bypass intent. Pinned by 8 new unit tests across `apns.test.ts` — one positive case for MEDICATION_REMINDER and a parameterised negative covering all six other event-types. Co-Authored-By: Claude Opus 4.7 (1M context) <noreply@anthropic.com>