A calm, structured evening on the terrace garden at Gracias Living, part of how routine helps residents settle before dusk
Sundowning is a pattern where people with dementia become more confused, agitated, restless, anxious, and disoriented in the late afternoon or evening. It is a behavioural change, not a separate disease. Families often see it in the middle stages of dementia, though the pattern varies a lot from person to person.
What causes sundowning?
Several factors overlap and reinforce each other. Mental fatigue builds up over the day. The internal body clock gets disrupted. Fading light creates confusing shadows. Hunger, thirst, pain, or discomfort goes unnoticed because the person cannot easily say what is wrong. Noise, visitors, and a busy household overstimulate the person in the evening.
Researchers do not fully understand the cause. The National Institute on Aging notes that sundowning may link to changes in the brain’s internal clock as dementia progresses.
What are the signs of sundowning?
Confusion, pacing, repetitive questions, agitation, suspicion of familiar people, a sudden urge to leave the house, mood swings, and trouble settling down for sleep. These signs appear in the late afternoon or evening. The Alzheimer’s Association also lists hallucinations and confusion about time or place as common signs.
When a sudden evening change may not be sundowning
Sundowning follows a pattern. It shows up around the same time on many evenings. A sudden change looks different. If your parent was calm yesterday and is confused, drowsy, or agitated today, do not assume it is sundowning.
Sudden confusion can point to another medical problem, such as:
- An infection, such as a urinary tract or chest infection
- Dehydration
- Pain that nobody has noticed
- Side effects from a new medicine or a change in dose
- Delirium, a sudden state of confusion that needs prompt medical assessment
Call the doctor the same day when the change is sudden. Older adults can have an infection without a fever, so a normal temperature does not rule it out. Seek urgent care when the confusion comes with a fall, breathing trouble, severe drowsiness, or difficulty waking the person.
How can families manage sundowning at home?
Keep evenings predictable with a consistent dinner and wind down routine. Turn lights on well before it gets dark. Limit afternoon caffeine and long naps. Reduce noise and household activity as evening approaches. Keep your tone calm and unhurried. Offer reassurance instead of correction when the person seems confused. Stick to the same faces and voices during this window whenever possible.
Your evening checklist for calmer evenings
Run through these eight points every afternoon.
- Lighting: Switch on lights before dusk. Close the curtains as it gets dark to reduce shadows and reflections.
- Hydration: Offer water and a light snack in the late afternoon.
- Toilet needs: Offer a toilet visit before the evening routine begins.
- Pain: Watch for frowning, groaning, or guarding a body part. Tell the doctor about any pain you suspect.
- Noise: Turn off the television and keep conversations quiet.
- Caffeine: Limit tea, coffee, and cola in the afternoon.
- Naps: Keep daytime naps short and early.
- Medication review: Ask the doctor to review the timing and side effects of every medicine. Never change a dose on your own.
What should you do during a sundowning episode?
- Stay calm and speak slowly in a soft voice.
- Offer reassurance instead of correcting the person.
- Do not argue about what is real.
- Gently guide the person to a familiar activity, such as folding towels, a snack, or a favourite song.
- Check basic needs: thirst, hunger, toilet, and pain.
- Stay with the person and keep doors secured when they try to leave.
- Never restrain the person or raise your voice.
Does sundowning get worse over time?
The pattern varies a lot from person to person. Many families notice it in the middle stages of dementia. For some people it changes over time. For others it continues or returns. Tell the doctor whenever the pattern changes, because a change may need a medical check.
Is sundowning the same as agitation?
No. Agitation is one possible symptom of sundowning. Sundowning also brings confusion, anxiety, suspicion, restlessness, and a change in personality, all tied specifically to the evening hours.
Can sundowning be prevented completely?
Not always. A steady routine, good lighting, and a calm environment reduce how often and how severely it happens. They cannot guarantee it will never occur.
When should families get professional help for sundowning?
Speak with a doctor when sundowning is frequent, severe, comes with wandering or aggression, leads to falls, or gets harder for the family to manage safely night after night. These signs can also come up during a wider dementia behavioural crisis, and the person may need more supervision than a family can give at home. Our dementia care guide covers how structured routines and medical oversight help manage this kind of behavioural change.
Sources
- National Institute on Aging: Coping with agitation, aggression, and sundowning
- Alzheimer’s Association: Sleep issues and sundowning
This article gives general information. It does not replace advice from your doctor.
By Dr. Chitra Anand, Head of Medical Services, Gracias Living. With 38+ years of clinical experience, Dr. Anand oversees medical care for every resident living with dementia at Gracias Living. Her approach looks beyond medication at how routine, environment, and daily rhythm affect behaviour like sundowning.
