Sundowning: What It Is, Why It Happens, and How to Manage It

If your loved one seems calm in the morning but grows confused, anxious, or agitated as the afternoon fades into evening, you’re likely watching a pattern called sundowning. It’s one of the most common and most misunderstood parts of caring for someone living with dementia. This article explains what sundowning with dementia is, why it happens, and what actually helps.

What Is Sundowning?

Sundowning is a pattern of increased confusion, agitation, restlessness, or anxiety that shows up in the late afternoon and evening in people living with Alzheimer’s disease or other forms of dementia. It’s a set of behavioral changes tied to the time of day, and it can range from mild irritability to pacing, shouting, or trying to leave the house. Sundowning affects a meaningful share of people with dementia, particularly in the middle stages, and tends to ease as their internal clock and environment become more predictable.

Signs of Sundowning to Watch For

Sundowning doesn’t look the same for everyone, but families and caregivers often notice a cluster of these behaviors starting in the late afternoon:

• Increased confusion about time, place, or people
• Restlessness or pacing
• Irritability or mood swings
• Anxiety or fearfulness
• Difficulty following conversations
• Wanting to leave home (“I need to go home” or “I have to pick up the kids”)
• Trouble settling down for sleep

For an adult daughter or son watching this unfold, the shift can feel disorienting and recognizing it as sundowning rather than a permanent decline is often the first source of relief.

Why Does Sundowning Happen?

Sundowning is not fully understood, but researchers point to a few likely contributors, and it’s rarely just one cause.

The brain’s internal clock is disrupted – Dementia damages the part of the brain that regulates the sleep-wake cycle. As daylight fades, the body’s normal cues for “wind down” get scrambled instead of reinforced.

Fatigue builds across the day – Processing conversations, navigating a room, and managing sensory input takes real cognitive effort. By late afternoon, that effort has accumulated, and the brain has less capacity left to filter and interpret the world calmly.

Light and shadow shift – Lower light and longer shadows can make familiar rooms look unfamiliar or unsettling, which can trigger fear or confusion in someone whose visual processing is already affected by dementia.

Routines break down at the end of the day – Mornings tend to be structured. Evenings often aren’t, and unstructured time can leave someone with dementia without the cues they rely on to feel oriented.

Physical needs go unmet – Hunger, thirst, needing the bathroom, or undiagnosed pain can surface as agitation rather than a clear request, especially when someone has trouble communicating what they need.

How to Ease Sundowning in the Evening

Small, consistent changes to environment, routine, and timing can reduce how often and how intensely sundowning shows up.

Adjust the Environment

• Turn on lights before the room starts to dim 
• Close curtains at dusk to reduce confusing shadows and reflections in windows 
• Reduce background noise from TV or multiple conversations happening at once to avoid competing sounds

Build a Predictable Routine

• Keep wake times, meals, and bedtime consistent every day 
• A familiar sequence in the evening, such as a favorite calm hobby or a warm drink at the same time each night, gives the brain a pattern to anticipate 

Watch Diet and Activity Timing

• Schedule bigger meals and more demanding activities earlier in the day
• Limit caffeine and sugar in the afternoon
• Encourage light physical activity, like a short walk, earlier in the day

Calm Presence  

• Use calm, simple language and avoid arguing or correcting during confused moments
• Offer reassurance rather than explanation when your loved one is anxious
• Keep a consistent caregiver or familiar face present during the evening hours when possible

Additional Considerations for Sundowning 

Talk to a physician if sundowning is new, worsening quickly, involves physical aggression, or is paired with signs of pain, infection, or a medication side effect. A physician can help recommend the best next step. 

If you’re noticing these changes in your parent or spouse and want to talk through what daily life could look like with more consistent support, Avalon Memory Care’s team is here to help you think it through. Our team has expertise in how to deal with dementia-related behaviors and can help provide a calm and caring atmosphere for your loved one. 

FAQ

What time of day does sundowning usually start?

Sundowning typically starts in the late afternoon, often between 4-7pm, and can continue into the night. The exact timing varies by person and can shift as dementia progresses. Some people experience it daily, while others notice it more on high-stimulation or high-fatigue days.

Does sundowning get worse over time?

Sundowning often intensifies during the middle stages of dementia and may lessen in later stages as daily rhythms simplify further. Consistent routines, better lighting, and reduced afternoon stimulation can noticeably reduce its frequency and severity at any stage.