Sundowning in Dementia: Why Evenings Get Harder
Sundowning is a pattern of confusion, restlessness or agitation that gets worse in the late afternoon and evening in many people living with dementia.
Sundowning is a pattern of confusion, restlessness or agitation that gets worse in the late afternoon and evening in many people living with dementia. It usually eases with a steady daily routine, bright daytime light, softer evening light, less caffeine and fewer late naps, plus checking for hidden problems like pain, hunger or an infection.
What is sundowning?
Sundowning isn't a disease. It's a name for a pattern caregivers know well: the person seems fine at lunch, then around four or five o'clock they start pacing, asking to "go home" when they're already home, or getting upset over small things. Some people shadow their caregiver from room to room. Others become suspicious or tearful.
It's common in Alzheimer's and can show up in other dementias too. It tends to appear in the middle stages, though timing varies a lot from person to person.
What causes sundowning?
Nobody has pinned down a single cause. The most likely explanation is a mix of things that pile up by the end of the day:
- Damage to the brain's internal clock, which makes the body less sure whether it's day or night
- Tiredness, both physical and mental, after a full day of trying to make sense of things
- Fading light and longer shadows, which can make a familiar room look strange or even frightening
- A busier household in the evening: dinner, TV, people arriving home
- Unmet needs the person can't put into words, such as pain, thirst, needing the toilet, or feeling too cold
Sudden sundowning, or a sharp change in how bad it is, deserves a call to the doctor. Urinary tract infections, constipation, poor sleep and new medications are common culprits in older adults, and all of them are treatable.
What helps with sundowning?
Most of what works is unglamorous, and it works better as a package than one trick at a time.
Get light early. Morning daylight helps reset the body clock. A walk outside or breakfast by a bright window counts. Some families use a light therapy lamp in the morning, though it's worth asking the doctor first, especially if the person has eye conditions.
Keep the afternoon calm. Schedule appointments, baths and visitors earlier in the day. Plan something quiet and familiar for the late afternoon: folding towels, a favourite album, looking at a photo book.
Cut back on caffeine and long naps. A short nap is fine. A two-hour nap at three in the afternoon can wreck the night.
Close the curtains before dark and turn the lights up. Reducing shadows and reflections in windows takes away some of what looks threatening.
Respond to the feeling, not the facts. If your mum keeps saying she needs to pick the kids up from school, arguing that the kids are now 50 won't help. "Tell me about them" usually goes further.
Can technology make evenings easier?
A little, if you keep it simple. Smart bulbs can brighten gradually through the morning and dim to a warm tone in the evening on a schedule, so nobody has to remember. Motion-activated night lights help with confused trips to the bathroom. A large-display clock that clearly says "Tuesday evening" answers the question of what time of day it is without anyone having to repeat it.
Door chimes and bed sensors let a tired caregiver rest without staying on high alert, which matters because sundowning often leads into night-time wandering. Our smart home room-by-room guide and our piece on GPS trackers and wandering go into the options in more detail.
When should you talk to a doctor about sundowning?
Call if the change is sudden, if the person could hurt themselves or someone else, or if you're not sleeping because of it. A doctor can look for infections, pain and medication side effects, and can review sleep problems such as sleep apnea. Medications are sometimes used for severe agitation, but they carry real risks in people with dementia, so they're usually a last resort after the practical steps above.
And keep an eye on yourself. Evenings are when caregivers are most worn out too. If sundowning is turning every night into a battle, that's a sign you need backup, not that you're doing it wrong.
Frequently asked questions
- What time does sundowning usually start?
- It usually begins in the late afternoon, often between about 4 and 6 pm, and can last into the night. The exact timing varies from person to person.
- Can sundowning happen without dementia?
- Yes. Older adults can have evening confusion during delirium, for example after surgery, during an infection or while in hospital. Any new confusion should be checked by a doctor.
- Does sundowning mean dementia is getting worse?
- Not necessarily. It is common in the middle stages, but a sudden change often has a treatable cause such as a urinary tract infection, pain, poor sleep or a new medication.
- Do light therapy lamps help sundowning?
- Some small studies suggest bright morning light can improve sleep and evening agitation. Evidence is mixed, so check with a doctor first, especially if the person has eye problems.
