The authors present a case of bilateral facial palsy in a 52-year-old man. The patient presented to an emergency department in Pennsylvania, describing left-sided neck pain and headache from "sleeping wrong," symptoms which eventually progressed to facial diplegia by his fourth visit in 2 weeks. His admitting diagnosis was Bell palsy; he was ultimately tested for and found to have Lyme disease. Delay in treatment of patients with Lyme disease may lead to bilateral facial paralysis and disease progression. Thorough history taking, physical examination, and scrutiny of prior records are important elements of identifying and treating patients such as these (ie, whose vague symptoms progress to facial diplegia) appropriately.