Sundowning is increased confusion, restlessness, or agitation that some people living with dementia experience in the late afternoon and evening. Predictable routines, good lighting, daytime activity, and a calm environment can help reduce it.
Sundowning can be exhausting for families. This guide explains common triggers and practical steps to try, along with when to involve a doctor.
What Is Sundowning?
Sundowning is not a disease itself but a pattern of symptoms. As daylight fades, a person may become anxious, pace, ask repeatedly to go home, become suspicious, or have trouble settling down. The exact causes are not fully understood. The Alzheimer’s Association discusses sleep issues and sundowning and lists factors that may contribute.
Possible Triggers
- Fatigue at the end of the day
- Low lighting and increased shadows
- Disrupted internal body clock
- Hunger, thirst, or discomfort
- Too much noise or activity
- Changes in routine or unfamiliar surroundings
- Unmet needs such as pain or needing the bathroom
Keeping a simple log of when episodes happen and what was going on beforehand can help you spot patterns.
Sundowning Strategies to Try
Keep a steady routine
Wake-up, meals, activities, and bedtime at consistent times help the body clock. Schedule appointments and outings for the morning when possible.
Get light and activity during the day
Time outdoors in the morning sun, gentle walks, and engaging activities can support better sleep. In El Paso, early morning is a pleasant time for a walk most of the year.
Calm the evening
Close blinds and turn on lights before dusk to reduce shadows. Lower noise, turn off loud television, and play soft music the person enjoys.
Limit stimulants
Reduce caffeine and sugar later in the day, and keep evening meals lighter.
Responding in the Moment
When agitation starts, stay calm and speak gently. Avoid arguing or correcting. Instead, acknowledge feelings: You want to go home; tell me about home. Redirect to a soothing activity, like looking at photo albums, folding towels, or having a snack.
Check for basic needs: hunger, thirst, temperature, pain, or the bathroom. Sometimes the cause is simple.
When to Talk With a Doctor
Sudden changes in behavior can be a sign of infection, pain, medication side effects, or other medical issues. Contact the person’s healthcare provider if sundowning appears suddenly or worsens, or if the person becomes a danger to themselves or others. Never adjust or add medicines without medical guidance.
Getting Evening Support
Late afternoons and evenings can be the hardest hours for family caregivers, who are often tired themselves. A caregiver trained in dementia support can help with the evening routine, provide companionship during restless hours, and give family members time to rest, cook dinner, or care for children. Consistent caregivers help, since familiar faces reduce anxiety.
Taking care of yourself is part of caring for someone with sundowning. Plan breaks, ask relatives to cover some evenings, and connect with a support group.
A Sample Calming Evening Routine
Every person is different, but a predictable evening rhythm helps many people living with dementia. Here is an example to adapt:
- 4:00 p.m.: Turn on lights and close blinds before shadows lengthen.
- 4:30 p.m.: A light snack and a drink, then a simple activity like folding laundry or sorting photos.
- 5:30 p.m.: Dinner at the same time each night, in a quiet room.
- 6:30 p.m.: Soft music, a short walk inside or on a porch, or looking at a favorite book.
- 7:30 p.m.: Begin the bedtime routine: washing up, comfortable clothes, and a familiar blanket.
Write the routine down so every family member and caregiver follows the same steps. Consistency across caregivers can matter as much as the routine itself.
Notice what works
Keep track of the evenings that go well. Was there more daylight activity? A visit from a grandchild? A quieter house? Building on what works is often more effective than trying to stop every difficult moment.
Sundowning and Sleep at Night
Restless evenings can lead to disrupted nights. Keep the bedroom comfortable, quiet, and at a pleasant temperature. Use night lights so the person can find the bathroom safely. Limit long daytime naps if they seem to affect nighttime sleep, but allow short rests when the person is tired. If nighttime waking is frequent, discuss it with the doctor, who can look for causes like pain or medication effects. Families who are up at night often need daytime coverage so they can rest.
Help for the Late-Afternoon Hours
Sundowning tends to land at the same time every day, which makes it one of the easiest stretches to plan coverage for. Our dementia care page explains how a caregiver can keep evenings calm, and Caring Companions has more about our approach. Call (915) 307-6103 to talk about evening support.
Frequently Asked Questions
What time of day does sundowning start?
It typically begins in the late afternoon and can continue into the evening and night, though timing varies.
Can sundowning happen without dementia?
Late-day confusion can occur in other situations, such as after surgery or during illness. Any new confusion should be checked by a healthcare provider.
How do you calm someone who is sundowning?
Stay calm, reduce noise, improve lighting, check basic needs, and redirect to a soothing activity rather than arguing.
Does sundowning get worse over time?
It can change as dementia progresses. Talk with the person’s doctor about changes in behavior.
Can a caregiver help with sundowning in the evenings?
Yes. A dementia-trained caregiver can follow a calming evening routine, provide companionship during restless hours, and give family members a chance to rest. Medical concerns about behavior changes should go to the person’s doctor.