Sundowning

One symptom of Alzheimer's and other forms of dementia is sundowning. It seems that the varying levels of brain deterioration that stems from Alzheimer's and dementia interact with the fading light of the day differently.

Sundowning can be upsetting and confusing for both the person with dementia and their family. This article explains what sundowning looks like, what may trigger it, and practical steps you can take to reduce its impact during evening hours.

What is sundowning?

Sundowning refers to a pattern of increased confusion, restlessness, anxiety, or agitation that often occurs in the late afternoon or evening. It can show up as trouble settling down, more repeating or pacing, sudden mood changes, or difficulty sleeping. Not everyone with dementia will have sundowning. When it does occur, it can make evenings harder for the person and for caregivers.

Common signs to watch for

Look for changes that happen as daylight fades or as the home gets quieter. Signs include:

• Increasing confusion or memory problems in the late day
• Irritability, anger, or tearfulness
• Restlessness, pacing, or wandering
• Repeating questions or statements more often
• Trouble falling asleep or staying asleep

These behaviors may come and go. They can last an hour or several hours and sometimes continue into the night.

What may cause sundowning

There is no single cause. Several factors often interact. Think of sundowning as a state where the brain is more sensitive to certain triggers. Common contributors include:

• Lower light and changing shadows that make the world harder to read
• Fatigue from a long day of activity or effort
• Overstimulation earlier in the day, like busy visits or noise
• Boredom from too little activity or mental stimulation
• Disruption of the normal sleep wake cycle
• Unmet physical needs such as hunger, thirst, pain, or needing the bathroom

Medications and other illnesses can also make symptoms worse. Try to spot patterns. Note when behaviors start, what was happening earlier, and how long they last.

Practical ways to help during evenings

Small changes can often ease sundowning. Try the following ideas and see what works for your loved one. Use one change at a time so you can tell what helps.

• Keep a calm routine. Regular times for meals, bathing, and bedtime give the day shape.
• Increase natural light during the day. Open curtains and spend time outdoors when possible.
• Use soft, even lighting in the evening to reduce harsh shadows and glare.
• Reduce noise and activity as evening approaches. Turn off the TV or lower voices during later hours.
• Offer a light snack or drink if hunger or thirst may be a factor.
• Provide gentle, reassuring reminders. Short, simple sentences work best.
• Offer a soothing activity like folding towels, listening to calm music, or looking through a simple photo album.
• Avoid caffeine and heavy meals late in the day. These can affect sleep.
• Encourage daytime activity and short, safe walks to reduce restlessness at night.
• Check pain, discomfort, or the need to use the bathroom. Addressing these needs can stop or prevent agitation.

Be patient and kind with yourself. Some nights may still be hard. Keep a list of what you tried and what helped for future reference.

When to seek more help

If sundowning gets worse, causes danger, or makes daily care impossible, ask for professional help. Talk with the person's doctor or a care team. They can help rule out medical causes such as infections, medication side effects, or other treatable problems. A care professional can also suggest changes in routine, home setup, or caregiving strategies.

If you feel overwhelmed or unsafe, reach out to other family members, friends, or community resources. Caring for someone with dementia is demanding. You do not have to do it alone.

Sundowning can be one of the harder parts of dementia care, but small changes in light, routine, and comfort often make a real difference. Watch for patterns, respond to needs, and be gentle with both your loved one and yourself.