Concomitant narcolepsy and sleep apnea (SA) can be present in the same patient. We present a patient with recurrent episodes of syncope and subsequent falls, which were found to be due to narcolepsy and Obstructive Sleep Apnea (OSA). She was initially treated with continuous positive airway pressure (CPAP) but continued to have symptoms sustaining injury. Her symptoms resolved with placement of a permanent pacemaker (PPM) implant and to date has not had any recurrence.