Sundowning in dementia describes a period of increased confusion, anxiety, agitation or other changes in behaviour that often become more noticeable during the late afternoon and evening. It is sometimes called sundowning syndrome or sundowner’s syndrome.
For families caring for someone with dementia, these changes can be difficult to understand. A person who appeared relatively settled during the morning hours may become restless, confused or anxious towards the end of the day.
Sundowning is associated with dementia, including Alzheimer’s disease, although not everyone living with dementia will experience sundowning. Understanding the symptoms of sundowning, identifying possible triggers and establishing a predictable routine can make these periods easier to manage.
At Careline Home Support, we support people living with dementia in their own homes. We understand that dementia affects every person differently, which is why support should always be based around the individual’s routines, preferences and changing needs.
What Is Sundowning in Dementia?
Dementia sundowning is a term used to describe changes in behaviour that typically occur or become worse later in the day.
According to the Alzheimer’s Society’s guidance on sundowning, sundowning is not necessarily caused by the sun setting and is not always limited to the evening hours. It can occur at different stages of dementia, although it is more common during the middle and later stages.
A person living with dementia may experience increased confusion, anxiety, restlessness or agitation during these periods.
The experience varies considerably between individuals. For some people, symptoms may begin in the late afternoon and improve later in the evening. Others may experience sleep problems or remain unsettled into the night.
This is one reason families should look at the individual’s behaviour and routine rather than expecting sundowning to follow exactly the same pattern for everyone.
What Are the Common Symptoms of Sundowning?
Sundowning symptoms can be behavioural, emotional or related to changes in a person’s awareness of their surroundings.
Common symptoms can include:
- increased confusion or disorientation
- anxiety or distress
- agitation and irritability
- restlessness or pacing
- difficulty recognising familiar surroundings
- changes in sleep patterns
- wanting to leave or go somewhere
- repeatedly asking questions
- increased dependence on a family member or carer
- difficulty settling during the evening
- in some cases, hallucinations or changes in perception
The symptoms of sundowning can look different from one day to another.
It is therefore useful to consider whether there is a pattern. Keeping a simple record of when the behaviour occurs, what happened beforehand and what helped the person settle can assist with identifying triggers.
Sudden or significant changes should not simply be assumed to be dementia related. If someone becomes unexpectedly confused or unwell, seek advice from an appropriate healthcare professional.
What Causes Sundowning?
The exact cause of sundowning is not fully understood.
Rather than there being one single cause, several factors may contribute to late day confusion and changes in behaviour.
The Alzheimer’s Society identifies possible triggers including tiredness, hunger, pain, unmet physical needs, insufficient exposure to natural light, overstimulation, sensory impairment and disruption to the body’s internal clock.
Changes to the Internal Body Clock
Dementia can affect the brain processes involved in regulating sleep wake cycles.
Our body clock helps regulate when we feel awake and when we become tired. Changes caused by dementia may make it more difficult for some people to distinguish between daytime and night-time.
Changes in natural daylight during the late afternoon and early evening may add to this confusion.
Providing exposure to natural sunlight during the day and maintaining consistent sleep schedules may help reinforce the distinction between daytime activities and evening rest.
Tiredness and Sleep Issues
Fatigue can make confusion and anxiety more noticeable.
If someone has been awake for much of the day or has experienced disrupted sleep, they may become increasingly tired towards the evening hours.
Sleep problems can themselves have many causes. If someone is consistently struggling to get enough sleep, waking repeatedly or experiencing another suspected sleep disorder such as sleep apnoea, it is sensible to discuss this with a healthcare professional rather than assuming sundowning is solely responsible.
Reduced Light and Increased Shadows
As natural light begins to disappear, increased shadows and changes in how a room looks can cause visual confusion.
Someone living with dementia may find it difficult to interpret what they are seeing, particularly if they also have impaired eyesight.
Keeping rooms comfortably and evenly lit during the transition from afternoon to evening can help minimise shadows and make the environment easier to interpret.
Overstimulation
A busy day can become tiring for anyone.
For a person living with dementia, excessive noise, unfamiliar people, appointments or too many stimulating activities may become particularly difficult to process towards the end of the day.
Reducing unnecessary noise and clutter can create a calmer environment.
Unmet Physical Needs
Behaviour can sometimes be a way of communicating a need that the person is struggling to express.
They may be hungry, thirsty, uncomfortable, in pain, too hot, too cold or need to use the toilet.
Before assuming a change in behaviour is sundowning, it can therefore help to consider whether there is a simpler physical explanation.
Can an Infection Make Sundowning Worse?
Changes in behaviour are not always caused by sundowning.
An infection, pain, dehydration, constipation or other health problem can cause increased confusion in someone with dementia. Urinary tract infections are one possible cause of sudden confusion, particularly in older people.
This is why a noticeable or sudden deterioration should be discussed with the person’s GP or another healthcare professional.
A medical review may identify an underlying problem that needs treatment.
Certain medications can also affect alertness or sleep. Medication should not be changed without appropriate medical advice, but a GP, pharmacist or other healthcare professional can review the person’s medication if there are concerns.
What Time Does Sundowning Start?
Despite the name, sundowning does not begin at a precise time.
For many people who experience sundowning, symptoms become more noticeable during the late afternoon and evening. However, the timing and severity can vary.
It can help to observe when symptoms typically occur for the individual.
If agitation regularly begins at a similar time each day, families and carers may be able to adjust the person’s routine beforehand. This might mean completing more demanding activities earlier, providing a meal or drink before the usual period of agitation or creating a quieter environment before symptoms normally begin.
How Long Does Sundowning Last?
There is no fixed length of time for a sundowning episode.
Symptoms may continue for part of the evening or for several hours. Some people settle as their normal bedtime approaches, while others experience sleep issues or remain unsettled during the night.
Looking for an individual pattern is therefore more useful than expecting symptoms to disappear after a particular period.
If sleep problems are persistent or the person is regularly distressed for long periods, speak to a healthcare professional.
How to Manage Sundowning
There is no single method that will completely prevent sundowning.
However, coping strategies and changes to the person’s environment may help manage sundowning and reduce agitation.
Maintain a Consistent Daily Routine
A consistent daily routine can provide familiarity and predictability.
Try to keep waking, meals, activities and bedtime at reasonably similar times each day where possible.
At Careline, we know how important familiar routines can be when supporting people with dementia at home. Rather than imposing a completely new schedule, care should work around the person’s established habits and preferences wherever practical.
This individual approach is part of the support we provide to people who need help to continue living comfortably at home.
Encourage Natural Daylight
Exposure to natural daylight during the day may help support the body’s internal clock.
Opening curtains in the morning, spending some time outside where appropriate or sitting in a bright room can all provide greater distinction between daytime and evening.
As the sun begins setting, switch lights on before rooms become dark. This can minimise shadows and reduce abrupt changes in the person’s surroundings.
Include Appropriate Physical Activity
Regular physical activity can support general wellbeing and sleep.
The appropriate level will depend on the person’s mobility, health and abilities. A short walk, gentle movement or another form of light exercise may be sufficient.
Where possible, stimulating activities are generally better earlier in the day rather than immediately before bedtime.
Create a Calmer Evening Environment
Reducing noise, clutter and unnecessary activity can help create a more reassuring environment.
Television, multiple conversations or people moving around the home can sometimes become overwhelming.
Calming techniques do not need to be complicated. Familiar music, a quiet conversation or another activity the person normally enjoys may help them feel more settled.
Communicate Calmly
Someone experiencing sundowning may genuinely perceive their surroundings differently.
Arguing about what is or is not happening is unlikely to reduce their anxiety.
Speak calmly, provide reassurance and acknowledge how the person is feeling. If they are focused on something that is upsetting them, gently redirecting their attention may be more helpful than repeatedly correcting them.
Consider Food and Caffeine
Hunger can contribute to agitation, so maintaining regular meals can be helpful.
Some people may find a lighter evening meal more comfortable. It can also be sensible to limit caffeine later in the day if it appears to affect sleep.
Any dietary changes should take account of the person’s nutritional needs and relevant medical advice.
What Careline Looks at When Supporting Someone With Sundowning
At Careline Home Support, we don’t assume that two people with dementia will need the same support.
We take time to understand the individual, including their established routine, personal care needs, mobility, medication support requirements and the times of day when additional reassurance may be needed. Careline’s home-care approach is based around individual care plans and getting to know the person’s needs before deciding which services are appropriate.
When dementia experience sundowning is part of someone’s care needs, consistency can become particularly valuable.
Familiar surroundings can help too. This is one of the advantages of receiving care at home. The individual can remain in an environment they recognise while receiving additional support with everyday tasks.
Careline requires staff to undertake best-practice dementia and Parkinson’s care training and provides personalised care packages based around individual needs and wishes.
For families, that support can also provide reassurance that they do not have to manage every difficult evening alone.
When Can Overnight Care Help?
Sundowning can become particularly challenging when increased confusion continues into the night.
Family carers may find themselves repeatedly waking to provide reassurance, assist with toileting or respond when their loved one becomes disorientated.
Careline’s support during the night is specifically available for people who require additional reassurance or practical assistance overnight, including people with dementia who become disorientated. Support can include personal care, mobility assistance, medication support, continence care, companionship and reassurance.
Depending on the person’s needs, this can involve either waking night care, where a carer remains awake, or sleeping night care where someone is available if assistance is required.
Where care needs become more extensive, continuous support at home may also be appropriate. Careline provides 24-hour care for people with dementia and other complex needs using carers working in shifts to maintain continuous support.
Supporting Family Carers
Caring for someone who experiences sundowning can affect the whole family.
Repeated periods of anxiety, agitation or disrupted sleep can become exhausting, particularly when one person provides most of the care.
Taking a break does not mean disrupting the person’s support.
Careline’s short-term support for family carers can provide temporary care in familiar surroundings while a regular carer rests or deals with other responsibilities. Careline also provides dementia-specific respite support designed around maintaining routines and continuity of care.
This can be arranged for a few hours, overnight or for longer periods depending on the family’s circumstances.
When Should You Seek Professional Advice About Sundowning?
Speak to the person’s GP or another healthcare professional if symptoms appear suddenly, change significantly or are causing concern.
This is particularly important if the person appears physically unwell, is in pain, has symptoms of an infection, experiences significant changes in sleep or develops new behaviour that is unusual for them.
A healthcare professional can consider whether another medical issue could be contributing and carry out a medical review where appropriate.
For ongoing dementia related behaviours, families can also discuss possible triggers, sleep patterns and non-drug approaches with healthcare professionals involved in the person’s care.
Helping Someone Live Well With Dementia at Home
Sundowning can be unsettling for both the person living with dementia and those caring for them, but identifying triggers and understanding the person’s individual pattern can make the symptoms easier to manage.
A predictable routine, natural light during the day, appropriate physical activity, good sleep habits and a calm environment may all form part of the approach.
Most importantly, support should remain centred on the individual.
At Careline Home Support, our carers support people with dementia in familiar surroundings while adapting care around their routines and needs. Whether that means companionship during difficult evening hours, personal care, overnight reassurance or more comprehensive support, the aim is to help each person remain as comfortable and independent as possible in their own home.
If your family needs additional support, you can explore the different ways Careline can help at home or contact our team to discuss the level of care that may be appropriate.
Michael Mensah brings over seven years of experience as a Nutritionist, guided by a genuine passion for improving people’s wellbeing. His strong commitment to supporting others in living with dignity and independence led him into the care sector.
He began his journey at Careline Home Support as a Care Worker, progressed to Team Leader, then Assistant Care Co-ordinator, and now works as a Care Co-ordinator. In this role, he provides personalised, person-centred care that respects each individual’s needs, while upholding the highest standards of compassion, safeguarding, and respect.
For Michael, caregiving is not just a profession but a meaningful exchange rooted in empathy. He believes that just as nature supports itself, those who need help should be met by those ready to offer it. His work brings him a deep sense of purpose, and he is proud to help foster a team culture built on kindness, professionalism, and mutual support.
