What is Sundowning?

What is Sundowning?

If your loved one is living with dementia  and becomes more confused, anxious, or agitated as evening approaches, they may be experiencing sundowning.

Sundowning, sometimes called sundown syndrome, is a common symptom of Alzheimer’s disease and other types of dementia. It describes a pattern where confusion, anxiety, restlessness, or challenging behaviours become more noticeable during the late afternoon, evening, or at night.

For families, this can be one of the most difficult parts of the day. The good news is that understanding what causes sundowning and learning a few practical strategies can make evenings calmer and less stressful.

What is Sundowning in Dementia?

Sundowning is not a disease or diagnosis on its own. Instead, it is a collection of symptoms experienced by some people living with dementia.

As daylight fades, a person may become:

• More confused about where they are
• Restless or unable to settle
• Anxious or fearful
• Irritable or easily upset
• Repetitive in their questions
• Suspicious of others
• More likely to wander
• Awake during the night

Symptoms usually improve by the following morning, although every person experiences dementia differently.

What causes Sundowning?

There isn’t one single cause of sundowning, but several factors are thought to contribute.

Changes in the brain 
Dementia affects the brain’s internal body clock, known as the circadian rhythm. As this becomes disrupted, distinguishing between day and night becomes more difficult.

Tiredness
By evening, many people with dementia are mentally and physically exhausted. Fatigue can make it harder to process information and cope with everyday situations.

Low light and shadows
As natural daylight disappears, shadows can make familiar surroundings seem unfamiliar or frightening. This may increase confusion or anxiety.

Hunger, thirst or physical discomfort
Being hungry, dehydrated, in pain, constipated, or needing the toilet can all contribute to agitation later in the day.

Too much stimulation
Busy days, noisy environments or too many visitors can leave someone feeling overwhelmed by evening.

Common symptoms of Sundowning

Signs of sundowning may include:

• Increased confusion
• Anxiety or panic
• Restlessness or pacing
• Mood swings
• Irritability
• Shouting or calling out
• Hallucinations
• Delusions
• Wandering
• Difficulty sleeping
• Refusing personal care

Symptoms often begin in the late afternoon and continue into the evening.

How to help someone with Sundowning

Although there is no cure for sundowning, simple changes to daily routines can often reduce symptoms.

Stick to a daily routine
Keeping meals, medication, activities and bedtime at consistent times provides reassurance and reduces uncertainty.

Encourage daylight and gentle exercise
Natural daylight helps regulate the body’s sleep-wake cycle. Short walks or sitting outside during the day may help improve sleep later on.

Create a calm evening environment
As evening approaches:

• Reduce background noise
• Turn off unnecessary televisions
• Play calming music
• Avoid stressful conversations
• Offer quiet activities such as reading or looking through family photographs

Improve Lighting
Switch lights on before it becomes dark to reduce shadows that may cause confusion.

Avoid caffeine late in the day
Tea, coffee, energy drinks and alcohol may interfere with sleep and increase restlessness.

Check for unmet needs
Ensure your loved one has:

• Eaten enough
• Had regular drinks
• Used the toilet
• Taken medication
• Comfortable clothing
• A comfortable room temperature

Offer gentle reassurance
Rather than correcting someone with dementia, acknowledge their feelings and calmly reassure them that they are safe.

When should you speak to a Doctor?

Sometimes worsening confusion isn’t caused by dementia alone. Contact a healthcare professional if symptoms suddenly become much worse or are accompanied by:

• Fever
• Pain
• Falls
• Sudden changes in behaviour
• Increased sleepiness
• Refusing food or drink

Medical conditions such as urinary tract infections (UTIs), dehydration, constipation or medication side effects can often make dementia symptoms temporarily worse.

Can Sundowning be prevented?

While sundowning cannot always be prevented, many people find that the following help:

• Consistent daily routines
• Good sleep habits
• Regular physical activity
• Plenty of daylight
• Calm evenings
• Managing pain or illness promptly
• Good hydration and nutrition

Small changes often make a significant difference over time.

Frequently asked questions

Is sundowning a sign that dementia is getting worse?

Not necessarily. Sundowning is common in moderate and later stages of dementia, but symptoms can vary from day to day. A sudden increase in confusion should always be discussed with a healthcare professional.

What time does sundowning usually start?

It often begins in the late afternoon or early evening as daylight fades, although it varies from person to person.

Does everyone with dementia experience sundowning?

No. Many people living with dementia never experience sundowning, while others only have occasional episodes.

Can medication stop sundowning?

Medication is not usually the first treatment. Healthcare professionals generally recommend environmental changes, routines and identifying underlying medical causes before considering medication.

How long does sundowning last?

Episodes can last from a few hours to most of the evening and often improve overnight or by the following morning.

How home care can support families

Having experienced dementia carers available can reduce stress for the whole family while helping someone remain safely in their own home.

If you’re supporting a loved one with dementia and finding evenings increasingly difficult, remember that you don’t have to manage alone. Contact us for advice or to arrange professional home care  where we can provide valuable support, helping your loved one to remain safe, comfortable and independent at home.

Professional home care can provide extra support to you by helping with:

• Evening personal care
• Meal preparation
• Medication reminders
• Companionship
• Reducing anxiety through familiar routines
• Supporting safe bedtime routines

Call:  0800 138 4030 or email: [email protected]