What is sundowning?

What sundowning looks like at home

Families usually describe the same clock-driven shift.

Your loved one is fairly settled at lunch, then around 4 or 5 p.m. starts pacing, asking to “go home” while already home, following you from room to room, or getting short-tempered over small things. Some people become suspicious, refuse directions, or try to leave the house. Others simply grow anxious and tearful as the light fades.

In Florida, early winter sunsets and the summer habit of drawing blinds against the heat both darken the house earlier, which many caregivers notice makes evenings harder.

Why it happens

No one knows the precise cause. Mayo Clinic lists likely triggers: fatigue at the end of the day, low light and shadows, a disrupted body clock, hunger or thirst, boredom, pain, depression, unfamiliar surroundings and infections such as a urinary tract infection. Brain changes from dementia make it harder for your loved one to make sense of these discomforts, so the distress comes out as restlessness instead.

What helps at home

• Keep wake-up, meal and bedtime at the same time every day.
• Get outdoor light and some movement in the morning; limit long afternoon naps.
• Keep caffeine and sweets to the morning.

As the afternoon goes on, shift to calming steps:

• Turn lamps on before dusk and use night lights to cut shadows.
• Lower the noise in the evening: TV off, fewer visitors, soft familiar music.
• In an unfamiliar place, such as a relative’s house or a hotel during a hurricane evacuation, bring familiar items like family photos.
• Offer a snack and a drink, and check for pain or a full bladder before assuming it is “just behavior.”
• Answer the feeling, not the words. “You’re safe, I’m staying with you” works better than arguing about where home is.

Mayo Clinic also notes that daytime bright light, sometimes combined with a low dose of melatonin, may help, but check with the doctor before trying any supplement.

Our blog post on sundowning and how to manage it goes deeper, and a steady daily routine is often the single most useful tool.

How sundowning changes across the stages

Late-day confusion is uncommon early on, when most people still manage their own routines. The Alzheimer’s Association describes the middle stage, usually the longest, as the time when sleep patterns shift: more dozing in the day and more restlessness at night. That is when most families first name the problem.

In the late stage, people often have less energy to pace or argue, and the evening distress may show up as moaning, calling out or resisting care instead. Because expressing pain gets harder at that point, treat a new evening pattern as a reason to look for discomfort first.

A short example evening

Here is one way a calmer evening can run. It is a template, not a rule; adjust the times to your loved one’s habits.

As the light starts to fade, shift the house into evening mode.

If an evening still goes badly, note what was different that day. Patterns usually show up within a week or two.

Sundowning checklist: what to track for the doctor

• The time the restlessness starts and how long it lasts.
• Naps that day, and how long each one was.
• Caffeine, sugar and fluids after lunch.
• Any new medicine or dose change in the past two weeks.
• Signs of pain, constipation, fever or burning urination.
• Snoring or pauses in breathing at night.

Our printable dementia care log has room for all of this.

When to call the doctor

Call your loved one’s doctor if evening confusion appears suddenly, gets markedly worse over a day or two, or comes with fever, burning urination, a new medicine, poor sleep with loud snoring, or signs of pain. Mayo Clinic notes that infections and sleep apnea can drive symptoms, especially when they start abruptly. A sudden change may be delirium, which needs prompt medical care.

Sundowning vs. delirium

Sundowning follows a daily rhythm and builds over weeks or months as dementia progresses. Delirium comes on over hours to a few days, swings through the whole day, and usually has a medical cause such as infection, dehydration or medication. When in doubt, treat a sudden change as delirium until a clinician says otherwise.

Florida help for hard evenings

The Alzheimer’s Association Helpline at 800-272-3900 answers 24 hours a day, every day, with interpreters in more than 200 languages, which is useful when the worst moments happen after office hours. For programs near you, including caregiver training and respite, call Florida’s Elder Helpline at 1-800-963-5337 to reach your local Aging and Disability Resource Center. Our Florida dementia resources page lists more.

How a companion can help

Many families book a dementia companion for the 3 p.m. to 8 p.m. window, when sundowning peaks and the family caregiver is most worn out. A familiar face, an early dinner, a walk before dusk and a calm wind-down can take the edge off. Our rate is $35 an hour for 40+ hours a week (call us about shorter schedules), and you can read how it compares in our Florida dementia care cost guide. If evenings are the hardest part of your week, respite care can give you a regular night off.

Related terms

• Delirium
• Agitation
• Wandering
• Alzheimer’s disease
• Lewy body dementia
• Caregiver burnout