If you care for someone with dementia, you may have noticed something shift in them as the afternoon fades into evening. They become more restless, more confused, maybe more agitated or fearful. By morning, they often seem like a different person again. What you’re witnessing is sundowning in dementia, and while it can be distressing for everyone involved, understanding what’s happening makes it much easier to manage.
What Is Sundowning in Dementia?
When problems like agitation and confusion start to happen or worsen in the late afternoon or early evening, it’s called sundowning.
It’s one of the more challenging aspects of caring for someone with Alzheimer’s disease or other forms of dementia. The person you know and love can seem to disappear for hours each evening, replaced by someone anxious, suspicious, or impossible to calm. For caregivers, especially those managing care at the end of a long day, sundowning in dementia is one of the most exhausting experiences to navigate.
Who Does Sundowning Affect?
Sundowning is most common in people with Alzheimer’s disease and other forms of dementia, though it can occasionally appear in older adults without a formal diagnosis, particularly during hospital stays. Epidemiological studies report a prevalence of sundowning syndrome in anywhere from 2.5% to 66% of patients with dementia syndromes, with variations tied to how the condition is defined and measured. What’s consistent across studies is that it tends to be more pronounced in the middle and later stages of dementia.
Common Symptoms of Sundowning in Dementia
Sundowning in dementia doesn’t look the same in every person. Some people become loud and agitated; others withdraw or pace. Common signs to watch for include:
- Increased confusion or disorientation in the late afternoon
- Restlessness or pacing
- Anxiety, fear, or suspicion of people around them
- Mood swings or sudden irritability
- Difficulty settling or falling asleep
- Hallucinations or paranoid thinking
- Yelling, crying, or aggressive behaviour
If you’ve noticed your loved one displaying some of these behaviours consistently around the same time each day, sundowning may be the cause.
What Causes Sundowning?
The causes of sundowning are not well understood. One possibility is that Alzheimer’s-related brain changes affect a person’s biological clock, leading to confused sleep-wake cycles. Other possible causes include being overly tired, unmet needs such as hunger or thirst, depression, pain, and boredom.
Fading light at the end of the day appears to be a significant trigger. As natural light decreases, the brain receives cues that can amplify confusion in someone already struggling with cognitive decline. Environmental factors, like shadows, noise changes, and the disruption that comes with a shift change in caregivers, can also play a role.
Practical Ways to Manage Sundowning in Dementia at Home
The good news is that sundowning in dementia can often be managed well with consistent, thoughtful strategies. It rarely disappears entirely, but its impact can be significantly reduced.
Stick to a Predictable Routine
Routine is one of the most powerful tools available to dementia caregivers. When a person with dementia knows what to expect and when, their anxiety decreases. Try to keep mealtimes, activities, and bedtime at the same time each day.
Increase Light During the Day
Taking steps to help prevent sundowning can include arranging daytime activities in naturally bright areas and ensuring good lighting in the late afternoon and evening when the sun begins to set. Consider a light therapy lamp in the living space during the afternoon hours.
Keep Afternoons Calm and Structured
Avoid scheduling demanding or stimulating activities in the late afternoon. A gentle walk earlier in the day, a quiet activity like sorting photographs, or listening to familiar music can help keep the afternoon manageable.
Watch for Triggers
Agitation and aggression often happen for a reason. Causes can include being pushed to do something that Alzheimer’s has made difficult or impossible, feeling lonely, certain medications, or interactions between medications. Keeping a short daily log of what happened before a sundowning episode can help you identify and remove triggers over time.
Create a Calm Evening Environment
Dim lighting in the evening, familiar objects within view, soft music, and a predictable wind-down routine can all signal to the brain that it’s time to settle. Reducing background noise like television news, which can be confusing and distressing, also helps.
Talk to a Doctor About Medications
If behavioral strategies aren’t enough, it’s worth speaking to your loved one’s doctor. A doctor can give the person with Alzheimer’s a medical exam to look for any physical problems that may cause agitation and aggression, and in certain cases, may prescribe medication to ease the symptoms. NCHStats
How a Caregiver Can Help
Professional caregivers who are experienced with dementia understand sundowning well and are trained to respond calmly, redirect effectively, and maintain the kind of routine that reduces its severity. If you’re finding evenings increasingly difficult to manage, having a trained caregiver present during peak sundowning hours can make a significant difference for both your loved one and for you.
Our article on how caregivers manage challenging dementia behaviours covers more of the day-to-day strategies that experienced caregivers use, and our tips for choosing a dementia-friendly caregiver can help you find the right person for your family’s situation.
You Don’t Have to Navigate This Alone
Sundowning in dementia is one of the hardest parts of caregiving. The evenings that were once peaceful can feel like a different life. But with the right support and the right strategies, they can become manageable again.
If your family needs guidance on dementia care or in-home support for a loved one, we’d love to help. Contact us to talk through your situation, explore our services, or find out if we serve your area.