Epilepsy is not one disease, and there are many different kinds of seizures. Some seizure types occur randomly. Others are not entirely random and can have an important relationship to sleep. A few types are highly predictable. If you keep careful records, you and your doctor may be able to identify seizure patterns and be better prepared.
One of the epilepsies most specifically related to sleep is called "awakening grand mal" epilepsy. If you have this kind of epilepsy, you have generalized tonic-clonic ("grand mal") seizures, but they occur only just before or just after you wake up. The seizures typically happen in the morning, but they can also occur when you wake up from a nap. Usually seizure medicines can control these seizures, but you should be cautious anyway during the times of greatest seizure risk. Don't operate machinery or be a caregiver for small children immediately after waking up.
Many other types of epilepsy include seizures that usually, but not always, happen upon awakening. Juvenile myoclonic epilepsy (JME) usually begins in the teenage years. People with JME have rapid, isolated jerks of muscles (similar to what most people experience as they fall asleep), called "myoclonus." There may be one jerk or repetitive jerks. If you have JME, you also may have grand mal seizures, usually early in the morning. Seizure medicines typically can control the seizures of JME.
Other seizure types tend to occur during sleep rather than upon awakening. Frontal lobe seizures are a type of partial epilepsy that begins in the frontal lobe, the part of the brain behind the forehead. Frontal lobe seizures are brief (generally not more than 2 minutes) and sometimes violent. They usually or always happen during sleep and can be followed by brief confusion. Seizure medicines tend to work better in controlling them if they occur only during sleep.
Children also can have forms of epilepsy in which seizures are restricted to periods of sleep. The most common type is called benign rolandic epilepsy (BRE), named after the brain region in which it starts. Jerking of the face, limbs, or both on one side almost always begins during sleep. The child usually wakes up and is alert. Usually an electroencephalogram (EEG) will be helpful to confirm the diagnosis. It is important to find out whether the child really has BRE, because it is always outgrown. Treatment is not always recommended, particularly if the seizures are rare and occur only during sleep. If seizure medicines are used, they are quite effective, typically at a very small dose.