If a loved one with dementia seems calm in the morning but becomes confused, anxious or restless as evening approaches, you may be seeing sundowning. It is common, it is not anyone’s fault, and there are practical ways to make late afternoons and evenings easier for everyone.
Quick takeaways
- Sundowning is increased confusion, restlessness or agitation in the late afternoon and evening, most often in people living with dementia.
- Tiredness, fading light, hunger, pain and changes in routine can all make it worse.
- A steady daily routine, bright light in the afternoon and a calm evening can help a great deal.
- Sudden or unusual changes in behavior should be checked by a doctor, since infections and medications can play a role.
What is sundowning?
Sundowning describes a pattern of increased confusion and agitation that tends to begin in the late afternoon and continue into the evening or night. It is most often seen in people living with Alzheimer’s disease and other forms of dementia, especially in the middle stages. You can learn more about how dementia changes over time in our guide to the stages of dementia.
Common signs of sundowning
- Restlessness, pacing or trouble sitting still
- Increased confusion about time, place or people
- Anxiety, irritability or mood swings
- Asking to “go home,” even when already at home
- Suspicion, shouting or resisting help
- Trouble falling asleep or staying asleep
What causes sundowning?
Experts do not know exactly why sundowning happens, but several factors seem to make it more likely:
- Fatigue at the end of a long day
- Fading light and shadows, which can be confusing or frightening
- A disrupted body clock, often linked to changes in the brain
- Hunger, thirst or pain that a person may not be able to explain
- Too much activity or noise late in the day
- Changes in routine, surroundings or caregivers
Health issues can also play a part. Infections such as a urinary tract infection, new medications and poor sleep can all bring on sudden confusion, so it is worth talking to a doctor about any new or worsening behavior.
Calm and consistency are often more powerful than any single technique.
Tips for managing sundowning
Keep a steady daily routine
Try to keep wake-up times, meals, activities and bedtime about the same every day. Predictable days help reduce anxiety. Plan outings, appointments and bathing for the morning, when many people are at their best.
Use light to your advantage
Spend time outside or near a bright window during the day. As afternoon turns to evening, turn on lights before it gets dark and close curtains to reduce shadows and reflections.
Create a calm evening
Lower the noise level, turn off busy television programs and keep visitors to a small number in the evening. Familiar music, a favorite blanket or a simple, soothing activity like folding towels can help.
Watch food, drink and naps
Offer a lighter meal in the evening and limit caffeine and alcohol later in the day. Short naps are fine, but long or late naps can make nighttime sleep harder.
Respond with reassurance
When agitation starts, stay calm, speak softly and avoid arguing. Acknowledge feelings (“I can see you’re worried”) and gently redirect attention to something familiar.
Taking care of yourself, too
Evenings with a loved one who is sundowning can be exhausting. Many caregivers find that regular breaks make it easier to stay patient and healthy. Our guides to respite care and caregiver burnout explain the options. When care needs grow beyond what can be managed at home, long-term care can provide around-the-clock support.
When to call a doctor
Contact a doctor if confusion comes on suddenly, gets much worse over a few days, or comes with fever, pain, falls or changes in eating or drinking. These can be signs of an infection or another treatable problem.
Frequently asked questions
What is sundowning?
Sundowning, sometimes called sundown syndrome, is a pattern of increased confusion, anxiety, agitation or restlessness that starts in the late afternoon and can continue into the night. It is most common in people living with Alzheimer’s disease and other forms of dementia.
What time of day does sundowning start?
It usually begins in the late afternoon or early evening, often as daylight fades, and can last into the night. The exact timing varies from person to person.
Can sundowning happen without dementia?
It is most closely linked with dementia, but similar evening confusion can happen in older adults after surgery, during a hospital stay or during an illness such as a urinary tract infection. Any new confusion should be checked by a doctor.
How can you calm someone who is sundowning?
Stay calm and speak gently, reduce noise and clutter, offer reassurance, and redirect attention to a simple, familiar activity. Arguing or correcting usually makes agitation worse.
Does sundowning get worse over time?
It often appears in the middle stages of dementia and may change as the condition progresses. Many families find that consistent routines and good sleep habits make a real difference.
This article is general information, not medical, legal or financial advice. Coverage rules can change, so confirm details with Medicare, your plan or your care team.
