What Is Sundowning in Dementia?

Dementia symptoms can change throughout the day. Someone who seems relatively calm and comfortable in the morning may become increasingly confused, restless, or distressed as the afternoon turns into evening. This pattern is often referred to as sundowning.

Sundowning is not a separate type of dementia. Instead, it describes a pattern of increased confusion, agitation, anxiety or other behavioural changes that can occur later in the day in some people living with dementia.

For families and carers, this can be difficult to understand. You may find that your loved one behaves very differently in the evening compared with earlier in the day. They may become restless, repeatedly ask the same questions, struggle to recognise where they are, or become anxious about going home.

Understanding what may be causing these changes can make it easier to respond when they happen.

What Does Sundowning Look Like?

Sundowning does not look the same for everyone. Some people may become mildly unsettled, while others can experience significant confusion or distress. You may notice your loved one:

• Becomes increasingly confused about where they are.
• Repeats the same questions.
• Becomes restless and has difficulty sitting still.
• Wants to leave or repeatedly asks to “go home”.
• Becomes anxious, irritable or upset.
• Has difficulty recognising family members or carers.
• Becomes more suspicious or fearful.
• Wanders around the home.
• Struggles to communicate what they need.
• Finds it difficult to settle or sleep.

Why Does Sundowning Happen?

There isn’t one single explanation for why sundowning occurs. It is likely to be influenced by several different factors, and what triggers it for one person may not affect another.

Fatigue can play a role. By the end of the day, someone with dementia may be tired from processing conversations, activities, and their surroundings. This can make existing confusion more noticeable.

Changes in the body’s internal clock may also contribute. Dementia can affect a person’s sleeping pattern, which may make it harder to maintain a regular distinction between daytime and nighttime.

Reduced light can add to this confusion. As the evening gets darker, shadows and changes in visibility may make familiar surroundings seem less recognisable.

Other factors may include hunger, thirst, pain, needing the toilet, changes to medication, an uncomfortable environment or a disruption to someone’s usual routine.

This is why it can be useful to look for patterns. If your loved one becomes unsettled at roughly the same time every evening, consider what happens immediately beforehand. Identifying a trigger can help you find ways to make the evening easier.

Is Sundowning a Sign That Dementia Is Getting Worse?

Sundowning can become more noticeable as dementia progresses, but this isn’t necessarily the case for everyone. It is important not to assume that every sudden behavioural change is simply part of dementia. Pain, infection, medication side effects, dehydration and other health problems can cause changes in behaviour or confusion.

If your loved one’s behaviour changes suddenly, particularly if they seem significantly more confused than usual, speak to their GP or healthcare team. A sudden change should be assessed rather than automatically being attributed to sundowning.

How Can You Help Someone Experiencing Sundowning?

There is no single approach that works for everyone experiencing sundowning. However, small changes to a person’s routine and environment may make evenings easier.

Keep the evening predictable. Familiar routines can provide reassurance. Try to keep meals, activities and bedtime around the same time each day where possible.

Keep the environment calm. Turn down the television, reduce unnecessary background noise and avoid overcrowding the room. As the evening gets darker, make sure rooms and hallways are appropriately lit.

Encourage activity during the day. Spending time outside in natural daylight and taking part in gentle activities can help maintain a regular daily routine. If your loved one sleeps for long periods during the day, this may make it harder for them to settle at night.

Don’t argue with them. If your loved one insists that they need to go somewhere or believes something that isn’t true, repeatedly telling them that they are wrong may only increase their distress. Instead, acknowledge how they are feeling and gently redirect their attention.

Check whether they need something. Restlessness can sometimes be a way of communicating an unmet need. Ask yourself whether they could be hungry, thirsty, uncomfortable, in pain, or need to use the toilet.

Most importantly, remember that the behaviour is not deliberate. Your loved one may be frightened or confused and unable to explain why. Remaining calm and reassuring can help them feel safer.

What Should You Avoid During Sundowning?

It can be tempting to correct someone when they are confused, especially when they are repeating the same question or insisting that something has happened when it hasn’t. However, repeatedly correcting them can sometimes increase their distress. Try to avoid:

• Arguing about what is true.
• Speaking loudly or becoming frustrated.
• Asking lots of questions at once.
• Introducing unnecessary changes to their evening routine.
• Treating distressed behaviour as deliberate.

Instead, try validation therapy to focus on helping them feel safe, reassured, and understood.

How Can Family Members Cope With Sundowning?

Supporting someone through sundowning can be exhausting, particularly when you are also trying to manage work, family responsibilities, and your own life. Don’t feel guilty if you find it difficult. Evening confusion can be unpredictable, and being responsible for someone distressed or trying to leave the house can be particularly demanding.

Make a note of when the symptoms usually begin, what happened beforehand, what your loved one ate and drank, and what seemed to settle them. Over time, this may help you identify patterns that aren’t immediately obvious.

It is also important to accept help or share the responsibility. Other family members may be able to share evening responsibilities, while respite care can give family carers a much-needed break. If sundowning becomes increasingly difficult to manage safely at home, it may also be time to consider whether your loved one would benefit from additional professional support.

How Is Sundowning Managed in a Care Home?

Moving into a care home does not necessarily mean that sundowning will disappear. However, having trained staff available throughout the day and night can provide additional support when symptoms occur.

Staff can monitor when a resident tends to become unsettled and look for patterns or potential triggers. These observations can be recorded in their care plan, giving the wider care team a clearer understanding of what may cause distress and what helps the resident feel settled.

For example, a resident may become anxious when the dining room becomes quieter after dinner. Knowing this, staff could spend some additional time with them, play familiar music or encourage them to take part in a calming activity before bedtime. A calm environment, consistent routines and personalised care can all help residents feel more secure.

Family members can also play an important role by telling staff about their loved one’s usual routines, interests, favourite music and anything that tends to cause distress. This information can help staff provide care that feels familiar and reassuring.

When Should You Seek Medical Advice?

If your loved one’s confusion or behaviour changes suddenly, don’t automatically assume that it is sundowning.

A sudden behaviour change can sometimes have another cause, such as an infection, pain, dehydration or a problem with medication. If you notice a significant change from your loved one’s usual behaviour, don’t wait for it to happen repeatedly before raising it with their healthcare team.

If there is an immediate risk of harm to your loved one or someone else, seek urgent medical assistance.

Supporting a Loved One Through Sundowning

Sundowning can be one of the more difficult aspects of dementia for families to manage. Seeing someone you know become confused or distressed in the evening can be upsetting, particularly when they seemed like themselves earlier in the day.

Keeping their routine familiar, creating a calm environment, and looking for possible triggers can all help. Most importantly, try to remember that the behaviour isn’t deliberate. Your loved one may be confused or frightened and unable to explain what they need.

If their needs become too difficult to manage safely at home, asking for additional support doesn’t mean that you have failed them. Professional dementia care can provide the supervision and reassurance they need, while allowing you to spend time with your loved one without having to carry the responsibility of caring for them alone.