Caregiver guide
Sundowning: what it is and how to help in the late afternoon and evening
Sundowning is when a person living with Alzheimer's or another dementia becomes more confused, restless, anxious or upset in the late afternoon and evening. It's common, it isn't anyone's fault, and there are simple things you can try tonight.
What is sundowning?
Sundowning (sometimes called sundown syndrome) is a pattern of late-day confusion and agitation in people living with dementia. It often starts as daylight fades, right when you're tired and need a break most.
Your person may pace, follow you from room to room, ask the same question again and again, or insist they need to "go home" even though they're sitting in the house they've lived in for years. Some people get angry or tearful. Others can't settle and won't go to bed.
If that sounds like your evenings, you're not alone. Sundowning is one of the behavior changes caregivers ask us about most. The good news is that small changes to the day often make evenings easier.
Symptoms of sundowning
Signs of sundowning usually show up or get worse in the late afternoon, evening or night. Watch for:
- More confusion than earlier in the day
- Restlessness, pacing or wandering
- Anxiety, worry or fear
- Irritability, yelling or arguing
- Asking to leave or "go home"
- Seeing shadows as people or things that aren't there
- Trouble falling asleep or staying in bed
Keep a simple log for a week or two: the time it started, what was happening and what helped. Patterns often jump out, and the log is useful to share with the doctor.
What time does sundowning start?
For most people, sundowning starts in the late afternoon or early evening, often around dusk. It can carry on into the night and make it hard for both of you to sleep.
The exact time is different for each person. Some caregivers notice a shift when the clocks change in the fall and it gets dark earlier. Your log will show you your person's usual "window", so you can plan calm activities just before it begins.
What causes sundowning?
Experts don't fully understand why sundowning happens. One idea is that dementia affects the brain's internal clock, so the person's sense of day and night gets mixed up.
Other things can set it off or make it worse:
- Being overtired, or having too busy a day
- Hunger, thirst or needing the bathroom
- Pain or discomfort they can't explain
- Boredom, or too little to do in the afternoon
- Depression or feeling lonely
- Low light and shadows that are hard to make sense of
- Noise, a crowded room or a change in routine
- Caffeine or alcohol later in the day
If sundowning suddenly gets much worse, call the doctor. An infection, pain, a new medicine or a sleep problem could be behind it.
What stage of dementia is sundowning?
Sundowning is most often noticed in the middle stages of dementia, but it can happen at any stage. Some families see it early on. For others it fades as the disease moves into the later stages.
Because every person is different, the stage matters less than the pattern. Focus on what time it happens and what seems to trigger it.
How to help someone who is sundowning
Stay calm and listen
Speak slowly and softly. Listen to the worry behind the words, and let your person know they're safe and you're there. Arguing or correcting usually makes things worse.
Meet the feeling, then redirect
If they want to go home, try "Tell me about home" instead of "You are home." Then gently move to something comforting, like a snack, a drink or a favorite photo album.
Make evenings quiet
Turn down the TV and skip the news or upsetting shows. Cut down on noise, clutter and visitors. Soft music, reading together or a short walk can help. Learn more about music in Remember My Song.
Light the house before dark
Close blinds or curtains at dusk and turn lights on early. This cuts down on shadows that can be confusing or frightening.
Give hands something to do
Simple tasks like folding towels, sorting socks or setting the table can ease restlessness and help your person feel useful.
Step away if you need to
If you feel your temper rising and your person is safe, leave the room for a few minutes. Take a few deep breaths. Your calm is contagious, and so is stress.
How can I prevent sundowning?
You can't always stop sundowning, but a steady, active day often leads to a calmer evening. Try to:
- Get daylight early. Time outside or by a sunny window in the morning helps set the body clock.
- Move every day. A walk, chair exercises or gardening helps with sleep at night.
- Keep naps short and early. A long or late nap can make bedtime harder.
- Keep a routine. Meals, baths and bedtime at about the same time each day help your person know what comes next.
- Don't overbook. Too many outings or visitors in one day can be tiring.
- Skip caffeine and alcohol later in the day. That includes coffee, tea, cola and chocolate in the afternoon.
- Plan the hard tasks for the morning. Baths, appointments and errands usually go better earlier.
If your person also gets up and walks around at night, read our guide to dementia wandering for safety tips.
When to call the doctor about sundowning
Call your person's doctor if sundowning is new, suddenly worse, or making it hard for either of you to sleep. A checkup can look for pain, an infection, a sleep problem or a side effect from medicine.
Bring your log and a list of every medicine and supplement your person takes. Ask whether any of them could add to late-day confusion.
If the doctor suggests a medicine to help with sleep or calm, ask about side effects. Some can raise the chance of dizziness, falls and more confusion, and many are meant for short-term use only. This page is general information, not medical advice. Always talk with your person's doctor.
If your person becomes aggressive or you feel unsafe, see our guide to dementia agitation and aggression. In an emergency, call 911.
You don't have to get through the evenings alone
Many caregivers tell us the evenings are the hardest part of the day. You may be running on very little sleep, and you may not have left the house in days. That's a sign you need more support, not that you're failing.
The Alzheimer's & Dementia Resource Center (ADRC) offers free help for caregivers in Central Florida:
- Caregiver support groups, in person and online, including evening groups, where other caregivers share what works for them.
- Care Navigation, free one-on-one sessions to build a plan for the hard times of day, in person in Winter Park or virtually.
- Education services, workshops and classes on understanding behavior changes.
Sundowning often shows up alongside other changes. See our guides to dementia behavior changes and hallucinations and paranoia.
Need someone to talk to right now, day or night? Call the Alzheimer's Association 24/7 Helpline at 800-272-3900. In an emergency, call 911.
Sundowning: common questions
What is the meaning of sundowning?
Sundowning means increased confusion, restlessness, anxiety or agitation that starts or gets worse in the late afternoon and evening. It mostly affects people living with Alzheimer's or another dementia.
Can sundowning happen without dementia?
Yes. Late-day confusion can also show up in older adults with delirium, after surgery or a hospital stay, or during an infection. If someone without a dementia diagnosis suddenly becomes confused in the evenings, call their doctor right away.
How do you treat sundowners?
Start with changes to the day: daylight in the morning, activity, short early naps, a steady routine, quiet evenings and good lighting before dark. If that isn't enough, talk to the doctor, who can check for pain, infection, sleep problems or medicine side effects. Any medicine should come from the doctor, who can explain the risks.
Can medications cause sundowning?
Some medicines can add to confusion or affect sleep, especially when a new one is started or the dose changes. Don't stop any medicine on your own. Ask the doctor or pharmacist to review everything your person takes, including over-the-counter sleep aids and supplements.
Why does my person keep asking to go home when we are home?
"Home" is often a feeling, not a place. It can mean safe, comfortable or the way life used to be. Instead of saying "You are home," try "You miss home. Tell me about it." Then offer comfort, a snack or a familiar activity. Many families see this most during sundowning hours.
Does sundowning ever stop?
It can come and go. Some people sundown for a period and then it eases, sometimes as the disease moves into later stages. Others have it on and off for a long time. Tracking patterns and adjusting the day usually helps more than waiting it out.
Is sundowning worse in winter?
Some caregivers notice it starts earlier when days are shorter and the clocks fall back. Turning lights on before dusk and getting more daylight in the morning may help.
Does sundowning mean the dementia is getting worse?
Not necessarily. Sundowning can come and go with tiredness, illness, stress or changes in routine. A sudden change in behavior should always be checked by the doctor, since it may have a medical cause.
How do I take care of myself when evenings are this hard?
Try to rest during the day when you can, and ask a family member or friend to call or visit during the late-day window. Join a free caregiver support group to talk with people who understand, or book a free Care Navigation session with ADRC at (407) 436-7750.
Download the free sundowning tip sheet
Print this one-page guide from the National Institute on Aging and keep it handy for hard evenings. This page is based in part on National Institute on Aging guidance.
Free help for dementia caregivers in Central Florida
The Alzheimer's & Dementia Resource Center (ADRC) in Winter Park, Florida, offers free help for caregivers in Orange and Seminole counties. Call (407) 436-7750, Monday to Friday, 8:30 AM to 4:30 PM.