Many families describe the same pattern. Mornings are okay. By late afternoon, Mom gets restless. By dinnertime she’s pacing, anxious, insisting she needs to go home, even though she is home. The evening becomes the hardest part of the day for everyone.
This pattern is often called sundowning. Understanding sundowning causes is the first step toward easing it. This guide explains what sundowning is, what triggers it, when it tends to appear, and the practical steps, including support from Alzheimer’s and dementia care professionals, that can make evenings calmer.
What is sundowning?
Sundowning is increased confusion, restlessness and agitation that begins around dusk and can continue into the night. The Alzheimer’s Association notes that it isn’t a disease itself, but a group of symptoms that can include trouble sleeping, anxiety, agitation, hallucinations, pacing and disorientation (Alzheimer’s Association). The National Institute on Aging describes it as restlessness, agitation, irritability or confusion that can begin or worsen as daylight fades (National Institute on Aging).
Common signs of sundowning include:
- Pacing, fidgeting or following you from room to room
- Asking to “go home” or saying they need to go to work or pick up the kids
- Increased confusion about where they are or who people are
- Irritability, suspicion, yelling or crying
- Seeing or hearing things that aren’t there
- Trouble settling down or staying asleep
Sundowning causes and triggers
The exact cause of sundowning isn’t known. The Alzheimer’s Association points to several factors that may contribute (Alzheimer’s Association):
- End-of-day exhaustion. Mental and physical fatigue builds up over the day.
- A mixed-up body clock. Dementia can disrupt the internal clock that tells us when to be awake and when to sleep.
- Low light and shadows. Fading light creates shadows that can be confusing or frightening.
- Unfamiliar surroundings. A new place, a hospital stay or rearranged furniture can increase confusion.
- Picking up on stress. A person with dementia may sense frustration or tension in the people around them and react to it.
- Dreams and broken sleep. Waking from a dream can blur what’s real.
NIA lists other common triggers of agitation, including pain, constipation, too little sleep, changes in routine, noise, pressure to do difficult tasks, loneliness and medication side effects (National Institute on Aging). Looking for these hidden causes often helps more than anything else, because many of them can be fixed.
What stage of dementia is sundowning?
Sundowning can happen at different points in dementia, but families often notice it during the middle stage. That’s when the Alzheimer’s Association says people commonly begin sleeping during the day and becoming restless at night (Alzheimer’s Association). It can continue into later stages as well. For an overview of what each stage looks like, see our Alzheimer’s progression timeline.
Does sundowning happen every night?
Not always. Sundowning varies from person to person and from day to day. Some people have evening symptoms most days. Others have good stretches and harder ones. Many families notice that bad evenings follow busy days, poor sleep the night before, missed naps or a change in routine.
Keeping a simple log for a week or two can reveal patterns: what time symptoms start, what happened earlier that day, what your loved one ate and drank, and what helped. That log is also useful to share with their doctor.
Can you get sundowning without dementia?
Evening confusion is most closely linked with Alzheimer’s and other dementias, but confusion that gets worse later in the day can also happen in other situations, especially in older adults who are ill, in pain, dehydrated or in the hospital. Sudden confusion, whether or not someone has dementia, can be a sign of a medical problem such as an infection or a medication reaction. If you notice a sudden change, call your loved one’s doctor right away.
Evenings getting harder at your house? We can help.
Tips for sundowning: how to make evenings calmer
These strategies, drawn from guidance by NIA and the Alzheimer’s Association, help many families (NIA; Alzheimer’s Association):
Through the day
- Keep a steady routine. Wake-up, meals, activities and bedtime at about the same times each day.
- Get sunlight. Time outdoors or near a bright window during the day supports the body clock.
- Stay active, but don’t over-schedule. A walk or simple chores help; a packed day can backfire.
- Plan demanding things for the morning. Schedule baths, appointments and visitors earlier in the day.
- Limit long or late naps. A short rest is fine; long afternoon naps can make nights harder.
- Cut back on caffeine and alcohol, especially later in the day.
As evening approaches
- Turn on lights before dusk. Bright, even lighting reduces confusing shadows.
- Close the curtains. Seeing darkness outside can trigger the urge to “go home.”
- Lower the noise. Turn off the TV news and keep conversations calm.
- Offer a comforting routine. Soft music, a familiar snack, a hand massage or looking through photos.
- Keep dinner simple. A lighter evening meal and fewer choices can help.
When agitation starts
- Stay calm and speak softly. Your tone matters more than your words.
- Don’t argue or correct. Acknowledge the feeling: “You’re worried. I’m right here.”
- Redirect gently to a walk, a snack or a simple task like folding towels.
- Check for basic needs: hunger, thirst, a full bladder, pain or feeling too hot or cold.
- Give space if it’s safe. Sometimes stepping back for a few minutes is enough.
If you ever feel your loved one or someone else is in danger, NIA advises calling 911 and telling the dispatcher that the person has dementia (NIA).
Activities for sundowners
Calm, familiar activities in the late afternoon can head off restlessness before it starts. Ideas that work for many families:
- Folding laundry, sorting socks or matching cards
- Looking through photo albums or a memory box
- Listening to favorite music from their younger years
- A short walk around the block or the garden before sunset
- Simple baking, setting the table or watering plants
- Petting a calm animal or holding a soft blanket
- Hand massage with lotion
The best activities match your loved one’s interests and current abilities. Something that feels productive, like helping with dinner, can be especially soothing for someone who spent their life caring for others.
When to talk to the doctor about sundowning
Sundowning is common, but it isn’t something you should simply put up with. Talk to your loved one’s doctor if:
- Evening symptoms appear suddenly or get much worse over a few days
- Your loved one seems to be in pain, constipated, or has signs of an infection, such as fever or burning with urination
- They’re seeing or hearing things that frighten them
- Agitation is putting them or others at risk
- Nobody in the house is sleeping
Bring your symptom log and a complete list of medications, including over-the-counter sleep aids and allergy pills. Some medicines can make confusion worse in older adults, and the doctor can review whether anything should change. Don’t start, stop or adjust medications on your own.
Taking care of yourself through hard evenings
Sundowning tends to hit just when family caregivers are running on empty. A few things help: eat and rest earlier in the day so you have reserves for the evening, trade off evening duty with a sibling or partner when you can, and remind yourself that the behavior is the disease, not your loved one’s true feelings about you. Regular breaks, even a few evenings a month, make it easier to stay patient over the long haul.
When sundowning leads to wandering or sleepless nights
For some people, evening restlessness turns into getting up at night, trying to leave the house, or wandering. That raises safety concerns for the whole family. Our guide to dementia wandering at night covers why it happens and how to keep your loved one safe.
Getting help with sundowning
Sundowning is exhausting, and evenings are often when family caregivers are most tired too. Having a trained caregiver in the home during the late afternoon and evening, or overnight, can make a real difference. A consistent, calm caregiver can keep the routine on track, prepare dinner, offer activities, and help your loved one settle into bed, while you rest or spend time as a son or daughter instead of a full-time caregiver.
Our caregivers are Teepa Snow-trained in supporting people living with dementia, with gentle approaches to redirection and reassurance. Care is available 24/7, including evenings, overnights, weekends and holidays. Many families start with just the hardest hours of the day.
Want help with the hardest hours of the day?
Care in the Sacramento area
Premier Comfort Care provides non-medical Alzheimer’s and dementia care in Sacramento, Folsom, Roseville, Granite Bay, El Dorado Hills, Elk Grove, Rocklin, Citrus Heights and nearby communities. When you call, you’ll talk directly with our owner, Mariam, about what evenings look like at your house and what would help most.
Sources: Alzheimer’s Association, Sleep issues and sundowning; National Institute on Aging, Coping with agitation, aggression and sundowning; Alzheimer’s Association, Stages of Alzheimer’s.
