What Is Sundowning in Dementia? Causes, Symptoms and Coping Strategies

Topic cluster: Dementia & Memory Care | Reading time: 5 min

If you've noticed that your parent becomes significantly more confused, agitated, or distressed in the late afternoon or evening, you may be witnessing a pattern known as sundowning. It's one of the most challenging aspects of caring for someone with dementia, and one of the least understood. This guide explains what sundowning is, what causes it, and what practical strategies can help.

What Is Sundowning?

Sundowning — sometimes called "late-day confusion" — refers to a pattern where dementia symptoms worsen during the late afternoon, evening, or night. It is not a formal medical diagnosis but is a well-recognised phenomenon that affects a significant proportion of people with dementia, particularly Alzheimer's disease and Lewy body dementia.

A person experiencing sundowning may:

Become increasingly confused, restless, or agitated as the day progresses
Pace, wander, or try to leave the house
Express distress, anxiety, or paranoia
Become verbally or physically aggressive
Resist going to bed or have significant difficulty sleeping
Hallucinate or misidentify people or objects

For family carers, evenings can become the most difficult and exhausting part of the day.

Why Does Sundowning Happen?

The exact cause is not fully understood, but several factors are thought to contribute:

Disruption to the body clock — dementia affects the brain's regulation of sleep-wake cycles (circadian rhythms). Light levels dropping in the evening may trigger confusion
Tiredness and sensory overload — cognitive reserves are depleted later in the day, making disorientation worse
Hunger or dehydration — physical needs that haven't been met can trigger agitation
Reduced stimulation — as activity drops in the evening, anxiety may fill the gap
Medication timing — some medications can contribute to confusion at certain times of day
Pain or discomfort — unaddressed physical discomfort often presents as agitation

Strategies That Can Help

No single strategy works for everyone — but trying a combination of approaches often produces improvement.

Environmental adjustments:

Keep the home well-lit in the late afternoon and evening; dimly lit rooms can increase confusion
Keep curtains open as long as possible to maximise natural light during the day
Reduce background noise in the evening (TV, radio) which can be disorienting
Create a calm, familiar, consistent environment

Routine and activity:

Ensure the daytime is well structured with regular activity and social engagement
Avoid long naps in the afternoon, which can disrupt nighttime sleep
Schedule demanding or stimulating activities earlier in the day
In the late afternoon, shift to quieter, calming activities — familiar music, gentle movement, hand massage

Meeting physical needs:

Ensure adequate food and fluids throughout the day
Check for signs of pain, constipation, or infection (UTIs are common and significantly worsen confusion)
Review medications with the GP — timing may be adjustable

In the moment:

Stay calm — agitation is contagious; your calm presence helps regulate theirs
Don't argue or try to reason — validate the feeling ("I can see you're upset, I'm here")
Redirect gently — a warm drink, a familiar activity, a gentle walk
Use touch and reassurance if welcomed

Checklist — daily sundowning prevention:

☐ Regular activity earlier in the day
☐ No long afternoon naps
☐ Good lighting throughout the home
☐ Regular mealtimes and adequate hydration
☐ Calm, quiet routine in the early evening
☐ GP review if new or worsening — especially to rule out UTI or medication issue

Light Therapy

Bright light therapy — exposure to a light therapy lamp (10,000 lux) for 30–60 minutes in the morning — has some evidence for improving sleep-wake cycles in people with dementia. It is relatively inexpensive to try. Speak to the GP or memory clinic for guidance.

When to Speak to the GP

Contact the GP if:

Sundowning appears suddenly or worsens rapidly (this can indicate infection, medication problems, or constipation)
Your parent is at risk of harm to themselves or others during episodes
Sleep disruption is severe and sustained
Current strategies are not helping

The GP may refer to the memory clinic or psychiatrist for further assessment. In some cases, short-term medication may be considered.

Impact on Carers

Sundowning is exhausting. It frequently disrupts sleep, creates safety risks, and can feel relentless. If you are a carer managing sundowning:

Accept help from family or professional carers to share evening and night-time responsibilities
Consider a care needs assessment to access funded evening or overnight care
Contact Admiral Nurses (Dementia UK, 0800 888 6678) — they provide expert support to family carers

Exploring care options? homeformum.com can help you find specialist dementia care homes where trained staff manage evening care and night-time support.