Editor’s Note: This article was originally published in 2023 and was completely updated in October 2026.
Does your loved one seem fairly calm during the day but become confused, anxious, restless, or upset as evening approaches?
They may begin pacing, asking to go home, searching for someone, resisting care, or insisting that they need to leave. They may follow you from room to room or become frightened by shadows and reflections.
Caregivers often call this sundowning.
Sundowning can be exhausting and confusing for everyone. But the behavior is not happening “for no reason.” Something may be making the late afternoon or evening harder for your loved one’s brain.
Instead of asking only, “How do I stop this behavior?” try asking:
“Why is this time of day becoming difficult?”
The behavior is the clue. Your job as a Dementia Detective is to look for the need behind it.
What Is Sundowning in Dementia?
Sundowning is a name used for changes that regularly begin or become worse in the late afternoon or evening. It is not a separate disease or a specific diagnosis.
A person experiencing sundowning may show:
- Increased confusion
- Anxiety or fear
- Irritability or agitation
- Pacing or restlessness
- Repeated questions
- Shadowing the caregiver
- Resistance to bathing, dressing, or bedtime care
- Asking to “go home”
- Searching for a person or place
- Hallucinations or suspicious thoughts
- Wandering or trying to leave
- Trouble settling down for the night
Not everyone living with dementia experiences sundowning. For those who do, the timing, signs, and triggers can be different.
Is It Sundowning or a Sleep Problem?
Sundowning and sleep problems can overlap, but they are not exactly the same.
Sundowning usually begins in the late afternoon or evening. You may notice confusion, fear, restlessness, or agitation as daylight fades.
A sleep problem may happen at any time during the night. Your loved one may have trouble falling asleep, wake frequently, sleep during the day, or have their days and nights mixed up.
Pay attention to when the change begins.
- Does it start around the same time every afternoon?
- Does it begin when the room becomes darker?
- Does it happen during dinner or evening personal care?
- Does it begin only after your loved one goes to bed?
- Are they awake but calm, or awake and frightened?
The timing can help you decide what to investigate first.
Related article: Why Is My Loved One With Dementia Up at Night?
Why Does Sundowning Happen?
There may not be one single cause. Several small problems can build throughout the day and become harder for the brain to manage by evening.
Possible triggers include:
Mental and Physical Fatigue
By late afternoon, your loved one’s brain may be tired from processing conversations, noise, movement, and daily tasks. Activities that went well in the morning may feel overwhelming later in the day.
Changes in the Body Clock
Dementia can interfere with the brain’s sleep-wake cycle. Your loved one may have trouble recognizing when it is daytime, evening, or time for sleep.
Fading Light, Shadows, and Reflections
As daylight fades, shadows grow and familiar rooms may look different. A dark doorway may look like a hole. A reflection in a window may look like another person. Poor vision can make this even more confusing.
Too Much Noise or Activity
Television, dishes, children, visitors, conversations, and evening chores can create sensory overload. Your loved one may not be able to sort out everything happening around them.
Hunger, Thirst, or the Need to Use the Bathroom
A person with dementia may feel uncomfortable without being able to explain what they need. They may not recognize hunger, thirst, constipation, or a full bladder.
Pain or Illness
Pain, infection, constipation, medication side effects, or another health problem may appear as confusion or agitation. A sudden change should never automatically be blamed on dementia or sundowning.
A Difficult Task at a Difficult Time
Bathing, changing clothes, eating dinner, or getting ready for bed may involve too many steps when the brain is already tired.
Become a Dementia Detective
When the evening becomes difficult, use the five Dementia Detective steps:
NOTICE
What exactly changed? Write down what you saw and heard instead of using only a general word like “agitated.”
Did your loved one pace, cry, call out, search for someone, refuse care, or try to leave?
LOOK
Look for physical, emotional, environmental, and task-related clues.
- Could something hurt?
- Are they hungry, thirsty, tired, too hot, or too cold?
- Do they need the bathroom?
- Is the room too dark, noisy, or busy?
- Are shadows or reflections confusing them?
- Is the task too difficult at this time of day?
ASK
Use short and simple questions.
- “Are you hurting?”
- “Would you like a drink?”
- “Do you need the bathroom?”
- “Would you like to sit with me?”
Do not ask several questions at once. Give them extra time to answer.
TRACK
Write down:
- What time it started
- What happened right before it
- What your loved one did or said
- What you tried
- What happened next
CONNECT
Look for a pattern. You may discover that difficult evenings happen after a busy day, before dinner, during personal care, when the room becomes dark, or on days when your loved one naps late.
Once you see the pattern, you can try changing one thing at a time.
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What Can You Do Before Sundowning Begins?
The best time to prepare for sundowning is earlier in the day.
Keep a Predictable Routine
Try to keep waking, meals, activity, rest, and bedtime at similar times. A familiar rhythm can help the day feel safer and easier to understand.
Encourage Morning Light
Open the curtains in the morning. When possible, spend time outside or sit near a bright window. Daytime light may help support the body’s internal clock.
Plan Demanding Activities Earlier
Schedule appointments, bathing, errands, and other difficult tasks in the morning or early afternoon when your loved one is usually more alert.
Balance Activity and Rest
Gentle activity during the day may reduce restlessness and support nighttime sleep. A short walk, folding towels, gardening, music, or another familiar activity may help.
Avoid an overly busy day. Too much activity can leave your loved one exhausted by evening.
Watch Late-Day Naps
A short rest may help, but a long or late nap can make bedtime more difficult. Watch your loved one’s pattern instead of assuming all daytime sleep is a problem.
Offer Food and Fluids Throughout the Day
Do not wait until dinner to meet most of their food and fluid needs. Offer drinks regularly and consider an afternoon snack if hunger seems to trigger evening changes.
Related articles: Dementia Nutrition and Dehydration in Dementia
Prepare the Home Before Dusk
Turn lights on before the rooms become dark. Good lighting may reduce confusing shadows.
Close curtains or blinds before the windows become reflective. Reduce clutter and keep familiar items easy to see.
Do not make the home so dim that your loved one cannot clearly see the room or the people around them.
What Should You Do When Sundowning Starts?
Even when you prepare, difficult evenings may still happen. The goal is not to win an argument or force your loved one to understand. The goal is to help them feel safe.
Start With Yourself
Pause before you approach. Lower your voice, relax your face, and slow your movements. Your loved one may notice your tone and body language even when they do not understand your words.
Offer Reassurance
Try simple phrases such as:
- “You are safe.”
- “I am here with you.”
- “We will take care of it.”
- “Let’s sit together.”
Do Not Argue About What Is Real
If your loved one says they must go home or pick up their children, correcting them may increase fear.
Respond to the feeling instead:
- “You miss home.”
- “You are worried about the children.”
- “You want to make sure everyone is safe.”
Then offer reassurance or gently guide them toward a familiar activity.
Check Basic Needs
Offer the bathroom, a drink, a light snack, a comfortable chair, or help changing position. Look for signs of pain, constipation, illness, or discomfort.
Reduce Stimulation
Turn down loud television or music. Limit the number of people talking. Pause unnecessary chores and create a quieter space.
Try a Familiar, Calming Activity
The right activity depends on the person. You might try:
- Listening to familiar music
- Looking through a photo album
- Folding towels
- Holding a familiar object
- Sitting together
- Taking a supervised walk
- Having a warm, caffeine-free drink if allowed
- Saying familiar prayers
If an activity makes them more upset, stop and try something else.
Allow Safe Movement
Your loved one may need to walk or pace. If it is safe, walk with them or provide a clear path. Do not physically restrain them unless trained emergency help is required to prevent immediate harm.
Make the Evening Safer
Sundowning may increase wandering and fall risks. Prepare before the difficult time begins.
- Clear floors and walking paths.
- Remove loose rugs and cords.
- Turn on lights before dusk.
- Use night-lights in the bedroom, hallway, and bathroom.
- Keep glasses, hearing aids, and mobility aids within reach.
- Make the bathroom easy to find.
- Secure medications, weapons, chemicals, and car keys.
- Consider a door alert if your loved one may leave the home.
- Keep current identification information and a recent photo available.
Safety tools can alert you, but they do not replace supervision when your loved one is at risk of wandering.
When Should You Call the Healthcare Provider?
Talk with the healthcare provider if sundowning is new, suddenly worse, happening more often, or creating safety concerns.
Call about changes such as:
- Sudden or severe confusion
- New pain, weakness, fever, or illness symptoms
- Urinary or bowel changes
- New hallucinations or a major change in behavior
- Falls or unsafe wandering
- Loud snoring, gasping, or pauses in breathing
- A recent medication change
- Extreme daytime sleepiness or a major sleep change
- Symptoms that are becoming difficult to manage safely at home
Ask the provider to look for treatable causes such as pain, infection, constipation, medication effects, depression, restless legs, or sleep apnea.
Seek emergency help for immediate danger or symptoms such as trouble breathing, chest pain, signs of a stroke, a serious injury, or a sudden severe change in alertness.
Do not start an over-the-counter sleep aid, melatonin, or another medication without checking with the healthcare provider. Some products can cause side effects, increase falls, or worsen confusion.
Track the Pattern
It is hard to remember every detail during a stressful evening. A written record can help you see connections that are easy to miss.
Track:
- The time the change began
- Meals, drinks, naps, and activities that day
- Pain or illness clues
- Bathroom and bowel changes
- Noise, visitors, shadows, or changes in routine
- Medications and the times they were given
- What you tried and whether it helped
One difficult evening may not show you much. Several days of notes may reveal a pattern.
Helpful tool: The Dementia Caregiver’s Notebook can help you track sleep, behavior, medications, pain, meals, bathroom changes, and the details you may need to share with the healthcare provider.
Frequently Asked Questions About Dementia Sundowning
What time does sundowning start?
There is no exact time. It often begins in the late afternoon or evening, but the timing may be different for each person. Track when it starts for your loved one.
Does sundowning happen every day?
It may happen daily, only on busy or tiring days, or only when certain triggers are present. A pattern can change as dementia progresses or when health needs change.
What stage of dementia does sundowning happen?
Sundowning can occur at different stages, but it is often noticed more as dementia progresses. Do not assume a new late-day change is “just the next stage.” Look for other possible causes.
Can pain cause sundowning behavior?
Pain can increase restlessness, resistance, confusion, and agitation. Look for grimacing, guarding, changes in walking, poor appetite, or resistance during movement and personal care.
Should I keep the lights dim in the evening?
The evening should feel calm, but the room should still be bright enough for your loved one to see clearly. Turn lights on before dusk and reduce shadows and reflections. Closer to bedtime, you can gradually create a quieter, restful setting without making walking areas unsafe.
Can medication treat sundowning?
There is no single medication that fixes sundowning. The healthcare provider should first look for triggers and treatable health problems. Non-drug approaches are usually tried first. Any medication decision should include a discussion of the possible risks and benefits.
How long does sundowning last?
It may last for a short period or continue into the night. Tracking the starting time, length, and possible triggers can help you and the healthcare provider understand the pattern.
The Behavior Is the Clue
Sundowning is not your loved one trying to give you a hard time. Their brain may be tired, confused, overwhelmed, uncomfortable, or frightened.
You may not be able to prevent every difficult evening. But you can prepare the environment, respond calmly, look for unmet needs, and track what happens.
Remember:
Notice the change. Look for the clue. Ask what they may need. Track the pattern. Connect what you learn.
The behavior is the clue. Look for the need behind it.
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