If you’ve noticed that your loved one with dementia becomes more confused, agitated, or anxious in the late afternoon or evening, you’re not imagining it. This pattern — known as sundowning — is one of the most challenging aspects of dementia care, and it affects a significant proportion of people living with Alzheimer’s disease and other forms of dementia.
The good news is that sundowning can be managed. With the right understanding and strategies, you can reduce its frequency and intensity, making evenings calmer and safer for both your loved one and yourself.
What Is Sundowning?
Sundowning — also called late-day confusion or sundowner’s syndrome — refers to a pattern of increased confusion, restlessness, anxiety, or agitation that typically occurs in the late afternoon and continues into the evening. It is not a separate disease but rather a symptom that commonly accompanies dementia, particularly in the middle and late stages.
The exact cause of sundowning is not fully understood, but researchers believe it is related to disruptions in the brain’s internal clock (the circadian rhythm) caused by the progression of dementia. As the disease damages brain cells, the body’s ability to regulate sleep-wake cycles deteriorates, leading to disorientation and agitation when daylight fades.
Common Signs and Symptoms
Sundowning can look different from person to person, and symptoms can vary in intensity from day to day. Common signs to watch for include increased restlessness or pacing in the late afternoon, heightened anxiety or emotional distress, sudden mood swings or irritability, confusion about time or place, increased suspicion or paranoia, repetitive behaviours like wringing hands or calling out, and difficulty settling or refusing to go to bed.
In Florida’s warm climate, additional factors can sometimes worsen sundowning — dehydration, overheating, or disrupted routines during hot summer months can all intensify symptoms.
What Triggers Sundowning?
While the underlying cause is neurological, several environmental and physical factors can trigger or worsen sundowning episodes. Understanding these can help you take proactive steps.
Fatigue: As the day wears on, a person with dementia tires more easily, which lowers their threshold for confusion and distress. Activities or appointments scheduled late in the day can tip the balance.
Low lighting: As daylight fades, shadows and dim lighting can create visual confusion — unfamiliar shapes, distorted depth perception, or difficulty recognising familiar spaces.
Disrupted routine: Any deviation from a predictable daily schedule — a visitor arriving late, a meal at an unusual time, or a nap at the wrong hour — can increase disorientation in the evening.
Hunger or thirst: Physical discomfort that the person cannot effectively communicate can manifest as agitation. Ensuring adequate nutrition and hydration throughout the day is essential.
Pain or illness: Underlying pain, a urinary tract infection (which is extremely common in older adults), constipation, or any physical discomfort can dramatically worsen sundowning symptoms.
Practical Strategies to Reduce Sundowning
There is no single solution for sundowning, but a combination of environmental, routine, and engagement strategies can make a significant difference.
Maintain a consistent daily routine. The brain with dementia depends heavily on predictability. Keep mealtimes, activity times, and bedtimes as consistent as possible from day to day. Even small variations can unsettle someone who is already struggling to orient themselves in time.
Maximise morning light exposure. Bright light in the morning helps regulate the circadian rhythm. Encourage outdoor activity or position your loved one near a window in the morning. In Florida, a gentle walk in the early morning sunshine can serve double duty as both light therapy and gentle exercise.
Reduce evening stimulation. Avoid noisy or exciting activities in the late afternoon. Turn off the television news (which can be particularly distressing), reduce household noise, and create a calmer atmosphere as the day winds down.
Improve indoor lighting. Before dusk, turn on all the lights in the main living areas. Bright, evenly distributed lighting reduces the visual confusion that shadows and dim light can cause. Night lights in hallways and bathrooms also help if your loved one is active in the night.
Use meaningful activity to redirect. Sometimes sundowning behaviour is rooted in the need for purpose or engagement. A simple, familiar task like folding laundry, listening to music, or looking at a photo album can redirect restless energy and reduce anxiety.
Offer a light snack in the late afternoon. Low blood sugar can worsen agitation. A small, nutritious snack around 3–4 pm — some fruit, crackers with cheese, or a warm cup of herbal tea — can help stabilise mood and energy before the evening begins.
Play soothing music. Familiar, calm music from your loved one’s past can have a remarkable calming effect during sundowning episodes. Keep a playlist ready for the late afternoon transition.
What to Do During an Episode
Even with the best prevention strategies in place, sundowning episodes will still occur. How you respond in the moment matters enormously.
Stay calm yourself — your emotional state is contagious. If you respond with stress or frustration, it will almost certainly escalate the situation. Take a slow breath, soften your voice, and approach with gentle reassurance.
Don’t argue or try to reorient by correcting their reality. If they believe it’s 1975 and they need to collect the children from school, gently validate the emotion (“I can see you’re worried — that makes sense”) and then redirect rather than correct (“Let me make you a cup of tea while we wait”).
Offer reassurance through touch if your loved one is comfortable with it. A gentle hand on the shoulder, holding hands, or a slow walk together can be more effective than words.
When to Speak to a Doctor
If sundowning is frequent, severe, or escalating in intensity, it’s important to speak to your loved one’s physician. Sometimes an underlying physical cause — pain, infection, a medication side effect — is contributing significantly and can be treated. In some cases, a doctor may discuss medication options to help manage severe agitation or sleep disturbance.
Keep a simple log of when episodes occur, how long they last, and what might have triggered them. This information is invaluable when speaking to a healthcare provider and can help identify patterns you might not otherwise notice.
You Don’t Have to Face This Alone
Sundowning is one of the most emotionally and physically exhausting aspects of dementia caregiving. Evenings that should be restful become fraught with uncertainty, and the relentlessness of it can wear even the most devoted caregiver down. Please know that this is entirely normal, and that asking for help is not a sign of failure — it’s a sign of wisdom.
At Dementia Companions, our trained in-home care professionals understand the rhythms and challenges of dementia, including sundowning. Whether you need support during the difficult evening hours or comprehensive daily care, we’re here to help your family find a calmer path forward. Contact us today to learn how we can support you.
