A calm, structured evening on the terrace garden at Gracias Living, part of how routine helps residents settle before dusk
Sundowning is a pattern seen in people with dementia where confusion, agitation, restlessness, anxiety, and disorientation increase in the late afternoon or evening. It is a behavioural change, not a separate disease, and it is most common during the middle stages of dementia.
What causes sundowning?
Several factors tend to overlap and reinforce each other: mental fatigue that builds up over the day, a disrupted internal body clock, fading light that creates confusing shadows, hunger or thirst the person cannot easily express, pain or discomfort that goes unnoticed, and overstimulation from noise, visitors, or a busy household in the evening. The exact cause is still not fully understood, and the National Institute on Aging notes it is likely linked 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 difficulty settling down for sleep, all appearing in the late afternoon or evening. The Alzheimer’s Association also lists hallucinations and disorientation about time or place as common signs.
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.
Does sundowning get worse over time?
It often peaks during the middle stages of dementia and can ease as the condition progresses further, though this varies from person to person.
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, but they do not guarantee it will never occur.
When should families get professional help for sundowning?
Speak with a doctor if sundowning is frequent, severe, paired with wandering or aggression, leads to falls, or is becoming harder for the family to manage safely night after night. These signs can also come up during a wider dementia behavioural crisis, and may mean a person needs more supervision than a family can provide at home. Our dementia care guide covers how structured routines and medical oversight help manage this kind of behavioural change.
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, and her approach looks beyond medication at how routine, environment, and daily rhythm affect behaviour like sundowning.
