Dementia Care: What is Sundowning?
Caring for someone with dementia can be particularly challenging, especially as daylight fades. This phenomenon, known as sundowning, often leads to increased confusion and agitation in individuals with dementia, making evening hours difficult for families.
Our clinical team frequently assists families in navigating this aspect of dementia care. In this article, we’ll explore the causes of sundowning, how to recognize its signs, and practical strategies to manage these challenging evening hours.
If you’re observing changes in your loved one’s mood or behavior, our guide on how to tell an elderly parent they need help provides gentle ways to initiate the conversation.
What is sundowning?
Sundowning refers to a pattern of increased confusion, agitation, or anxiety that typically occurs in the late afternoon or early evening. It is estimated to affect around 20% of individuals with dementia, and this figure rises to approximately 80% in residential care settings.
As daylight diminishes, individuals with dementia may become restless, irritable, or emotionally distressed, with symptoms typically easing by morning. Understanding the reasons behind this behavior can help you support your loved one during these challenging times.
What causes sundowning in dementia?
While the exact cause remains unclear, researchers suggest that a combination of biological and environmental factors may contribute to sundowning.
- Disrupted circadian rhythm – Dementia can interfere with the brain’s internal clock, which regulates sleep, wakefulness, and mood. As natural light fades, this disruption can lead to confusion or agitation.
- Mental and physical exhaustion – By late afternoon, individuals with dementia may have depleted their energy. When communication becomes difficult, agitation may manifest as a way to express discomfort, thirst, or fatigue.
- Environmental factors – Poor lighting, background noise, unfamiliar routines, or overstimulation can all contribute to evening confusion.
- Sensory difficulties – Changes in vision or hearing can make environments feel more confusing as darkness approaches.
Recognizing these triggers allows you to create a calmer evening atmosphere and prevent distress before it escalates.
Recognising the signs of sundowning
Symptoms of sundowning can vary between individuals and often become more pronounced as dementia progresses. Episodes typically begin around sunset and may continue into the night, disrupting sleep for both the person with dementia and their family.
Common signs include confusion, emotional outbursts, pacing, restlessness, paranoia, hallucinations, and disrupted sleep.
Specific symptoms include:
- Confusion or disorientation
- Increased agitation or emotional outbursts
- Pacing or wandering
- Restlessness or anxiety
- Paranoia, such as hiding possessions or mistrusting familiar people
- Hallucinations
- Difficulty sleeping or reversed sleep patterns
As dementia advances, sundowning symptoms may merge with other behavioral changes. It’s essential to discuss any new or worsening symptoms with your GP or clinical care team to adjust support accordingly.
When does sundowning occur in dementia?
Sundowning is most prevalent in the middle to late stages of dementia and can affect individuals with all types of dementia – including Alzheimer’s disease, vascular dementia, frontotemporal dementia, and Lewy body dementia.
Once episodes begin, they may lengthen and disrupt normal sleep patterns, creating a cycle of fatigue and worsening confusion. While sundowning cannot be entirely prevented, symptoms can be managed through consistent routines, a calming environment, and professional support.
Professional live-in carers trained in dementia care can help establish patterns that reduce late-day stress and provide reassurance during difficult periods.
Can sundowning happen without dementia?
Yes, sundowning-like symptoms can occur in older adults without a dementia diagnosis. As the brain ages, its ability to regulate sleep and respond to stress diminishes, leading to evening irritability, anxiety, or restlessness.
Individuals with anxiety disorders may also experience evening agitation when their sleep-wake cycle is disrupted. Mental strain accumulated throughout the day can peak in the late afternoon, causing restlessness even in otherwise healthy adults.
If you notice these signs in someone without a dementia diagnosis, consult their GP. Some reversible causes, such as medication side effects, depression, or infections, can produce similar symptoms.
Managing sundowning: Practical strategies
While there’s no single treatment for sundowning, a structured and reassuring routine can significantly alleviate symptoms. Our clinical team recommends the following approaches:
- Maintain consistent daily routines – Predictability reduces anxiety and helps your loved one feel more secure.
- Support healthy sleep patterns – Limit caffeine and daytime naps to encourage restful nighttime sleep.
- Encourage daytime activity – Gentle exercise and exposure to natural light help support the body’s circadian rhythm.
- Create a calm evening environment – Use soft, consistent lighting to prevent shadows and confusion. Reduce background noise and visual clutter.
- Provide reassurance and companionship – Your calm presence and gentle conversation help your loved one feel safe during periods of agitation.
- Use familiar music – Playing music they know and enjoy can soothe distress and provide comfort.
If these episodes become unpredictable or unsafe, a professional dementia carer can help defuse tense situations and support daily routines safely at home. If symptoms worsen or significantly disrupt daily life, discuss medication options with your GP. Low-dose melatonin or other medications may help in some cases, but should only be used following a professional assessment.
For additional guidance on managing challenging behaviors, read our article on aggressive behavior in dementia.
Supporting your loved one through sundowning
Sundowning can be distressing for both the person with dementia and their family. However, understanding its causes and recognizing the signs allows you to respond with confidence. By establishing calm routines and creating a reassuring environment, you can help reduce the frequency and intensity of these difficult episodes.
If you need additional support managing sundowning or other aspects of dementia care, our clinical team is here to provide guidance tailored to your family’s situation.
Caring for someone with dementia can be particularly challenging, especially as daylight fades. This phenomenon, known as sundowning, often leads to increased confusion and agitation in individuals with dementia, making evening hours difficult for families.
Our clinical team frequently assists families in navigating this aspect of dementia care. In this article, we’ll explore the causes of sundowning, how to recognize its signs, and practical strategies to manage these challenging evening hours.
If you’re observing changes in your loved one’s mood or behavior, our guide on how to tell an elderly parent they need help provides gentle ways to initiate the conversation.
What is sundowning?
Sundowning refers to a pattern of increased confusion, agitation, or anxiety that typically occurs in the late afternoon or early evening. It is estimated to affect around 20% of individuals with dementia, and this figure rises to approximately 80% in residential care settings.
As daylight diminishes, individuals with dementia may become restless, irritable, or emotionally distressed, with symptoms typically easing by morning. Understanding the reasons behind this behavior can help you support your loved one during these challenging times.
What causes sundowning in dementia?
While the exact cause remains unclear, researchers suggest that a combination of biological and environmental factors may contribute to sundowning.
- Disrupted circadian rhythm – Dementia can interfere with the brain’s internal clock, which regulates sleep, wakefulness, and mood. As natural light fades, this disruption can lead to confusion or agitation.
- Mental and physical exhaustion – By late afternoon, individuals with dementia may have depleted their energy. When communication becomes difficult, agitation may manifest as a way to express discomfort, thirst, or fatigue.
- Environmental factors – Poor lighting, background noise, unfamiliar routines, or overstimulation can all contribute to evening confusion.
- Sensory difficulties – Changes in vision or hearing can make environments feel more confusing as darkness approaches.
Recognizing these triggers allows you to create a calmer evening atmosphere and prevent distress before it escalates.
Recognising the signs of sundowning
Symptoms of sundowning can vary between individuals and often become more pronounced as dementia progresses. Episodes typically begin around sunset and may continue into the night, disrupting sleep for both the person with dementia and their family.
Common signs include confusion, emotional outbursts, pacing, restlessness, paranoia, hallucinations, and disrupted sleep.
Specific symptoms include:
- Confusion or disorientation
- Increased agitation or emotional outbursts
- Pacing or wandering
- Restlessness or anxiety
- Paranoia, such as hiding possessions or mistrusting familiar people
- Hallucinations
- Difficulty sleeping or reversed sleep patterns
As dementia advances, sundowning symptoms may merge with other behavioral changes. It’s essential to discuss any new or worsening symptoms with your GP or clinical care team to adjust support accordingly.
When does sundowning occur in dementia?
Sundowning is most prevalent in the middle to late stages of dementia and can affect individuals with all types of dementia – including Alzheimer’s disease, vascular dementia, frontotemporal dementia, and Lewy body dementia.
Once episodes begin, they may lengthen and disrupt normal sleep patterns, creating a cycle of fatigue and worsening confusion. While sundowning cannot be entirely prevented, symptoms can be managed through consistent routines, a calming environment, and professional support.
Professional live-in carers trained in dementia care can help establish patterns that reduce late-day stress and provide reassurance during difficult periods.
Can sundowning happen without dementia?
Yes, sundowning-like symptoms can occur in older adults without a dementia diagnosis. As the brain ages, its ability to regulate sleep and respond to stress diminishes, leading to evening irritability, anxiety, or restlessness.
Individuals with anxiety disorders may also experience evening agitation when their sleep-wake cycle is disrupted. Mental strain accumulated throughout the day can peak in the late afternoon, causing restlessness even in otherwise healthy adults.
If you notice these signs in someone without a dementia diagnosis, consult their GP. Some reversible causes, such as medication side effects, depression, or infections, can produce similar symptoms.
Managing sundowning: Practical strategies
While there’s no single treatment for sundowning, a structured and reassuring routine can significantly alleviate symptoms. Our clinical team recommends the following approaches:
- Maintain consistent daily routines – Predictability reduces anxiety and helps your loved one feel more secure.
- Support healthy sleep patterns – Limit caffeine and daytime naps to encourage restful nighttime sleep.
- Encourage daytime activity – Gentle exercise and exposure to natural light help support the body’s circadian rhythm.
- Create a calm evening environment – Use soft, consistent lighting to prevent shadows and confusion. Reduce background noise and visual clutter.
- Provide reassurance and companionship – Your calm presence and gentle conversation help your loved one feel safe during periods of agitation.
- Use familiar music – Playing music they know and enjoy can soothe distress and provide comfort.
If these episodes become unpredictable or unsafe, a professional dementia carer can help defuse tense situations and support daily routines safely at home. If symptoms worsen or significantly disrupt daily life, discuss medication options with your GP. Low-dose melatonin or other medications may help in some cases, but should only be used following a professional assessment.
For additional guidance on managing challenging behaviors, read our article on aggressive behavior in dementia.
Supporting your loved one through sundowning
Sundowning can be distressing for both the person with dementia and their family. However, understanding its causes and recognizing the signs allows you to respond with confidence. By establishing calm routines and creating a reassuring environment, you can help reduce the frequency and intensity of these difficult episodes.
If you need additional support managing sundowning or other aspects of dementia care, our clinical team is here to provide guidance tailored to your family’s situation.
