If your loved one with dementia becomes more confused, agitated, or restless in the late afternoon or evening, you are not alone. This pattern, known as sundowning, is common. According to the Alzheimer's Association, as many as 1 in 5 people with Alzheimer's disease experience sundowning.

This article explains what sundowning is, why it happens, and what families can do to manage it.

What Is Sundowning?

Sundowning refers to a pattern of increased confusion, agitation, anxiety, or restlessness that occurs in the late afternoon and evening. It is not a disease itself but a group of symptoms that can occur with dementia.

Common signs include:

✓Increased confusion or disorientation as the day goes on
✓Agitation, irritability, or anxiety in the late afternoon
✓Pacing, wandering, or restlessness
✓Mood swings or emotional outbursts
✓Difficulty settling down for the evening
✓Resistance to care or redirection
✓Hallucinations or paranoia in some cases

Sundowning typically peaks in the late afternoon and early evening and may improve as night falls.

Why Sundowning Happens

The exact cause is not fully understood, but several factors likely contribute:

Fatigue

By the end of the day, the person may be mentally and physically exhausted. The effort of processing information and navigating daily tasks with dementia is tiring, and fatigue can worsen symptoms.

Changes in Light

As natural light fades in the late afternoon, it can be disorienting. Shadows may be misinterpreted as people or obstacles. The change from daylight to darkness may trigger confusion about time.

Disruption of the Body Clock

Dementia can affect the brain's internal clock, making it harder to distinguish day from night. This can lead to confusion about whether it is time to be active or to sleep.

Overstimulation

A busy day with lots of activity, visitors, or noise can be overwhelming. By the late afternoon, the accumulated stimulation may become too much, leading to agitation.

Unmet Needs

Hunger, thirst, pain, or the need to use the bathroom can contribute to agitation, especially if the person cannot express what they need.

Medication Timing

Some medications may wear off in the late afternoon, or the timing of medications may contribute to changes in behavior.

Strategies for Managing Sundowning

Establish a Calm Evening Routine

Create a predictable, calming routine for the late afternoon and evening:

✓Reduce noise and activity as the day winds down
✓Turn off the TV and limit visitors in the late afternoon
✓Play soft, familiar music
✓Encourage a rest period in the late afternoon
✓Keep the evening meal at a consistent time
✓Follow the same bedtime routine each night

Use Light Strategically

Light plays a major role in sundowning:

✓Maximize natural light during the day. Open curtains and spend time outdoors or near windows. Natural light helps regulate the body clock.
✓Turn on lights before the sun goes down. Do not wait until the room is dark. Turn on lights in the late afternoon so the transition from day to evening is gradual.
✓Use warm, soft lighting in the evening. Avoid harsh, bright lights that can be overstimulating.
✓Close curtains before sunset. This prevents shadows from forming, which can be confusing.

Reduce Stimulation

✓Limit visitors and phone calls in the late afternoon
✓Avoid starting new activities or tasks after 3 or 4 PM
✓Keep the environment calm and quiet
✓Avoid large meals, caffeine, and alcohol in the evening

Address Physical Needs

✓Make sure your loved one has eaten and had enough to drink
✓Use the bathroom before settling in for the evening
✓Check for pain or discomfort
✓Ensure the room temperature is comfortable

Encourage Daytime Activity

A person who is active during the day is more likely to rest in the evening:

✓Encourage gentle exercise like walking or stretching
✓Provide engaging activities during the day
✓Limit daytime napping to 30 minutes or less
✓Spend time outdoors if possible

For more on activities, see our article on meaningful activities for seniors with dementia.

Avoid Arguing

If your loved one becomes agitated, do not argue or try to reason. Use validation and redirection:

✓Acknowledge their feelings: "I can see you are upset. I am here with you."
✓Redirect to a calming activity: "Let us sit together and listen to some music."
✓Do not correct or contradict unless there is a safety issue

For more on communication, see our article on communicating with someone who has dementia.

Consider Medication Timing

Talk with the doctor about whether any medications might be contributing to sundowning. Sometimes adjusting the timing of medications can help. Do not change medications without consulting the doctor.

When to Seek More Support

Sundowning can be exhausting for family caregivers. If you are losing sleep or feeling overwhelmed, it may be time for more support:

✓Overnight care can help if sundowning extends into the night. A caregiver who stays awake through the night can manage agitation and keep your loved one safe.
✓Evening care can provide coverage during the high-risk sundowning hours, giving you a break.
✓Daytime engagement from a caregiver can help your loved one stay active during the day, which may reduce evening agitation.

See our article on when dementia caregivers need more help for more.

The GUIDE Program

If your loved one is enrolled in Medi-Cal and has a dementia diagnosis, the GUIDE program may provide additional support, including care coordination and caregiver support. See our GUIDE dementia care program page for more.

A Final Note

Sundowning is one of the most challenging aspects of dementia care, but it can be managed. The key is a calm, predictable environment, attention to physical needs, and enough daytime activity to promote rest in the evening. And do not forget to take care of yourself. If you are exhausted, everything becomes harder.

If you would like help caring for a loved one with sundowning, Healthy at Home offers a free care assessment. Our dementia-trained caregivers can help, including overnight and evening care.

Managing Evening Confusion and Sundowning at Home