Dementia and Sundowning: Why It Happens and How to Ease It
By Louise Donaghy · Published 2026-05-22
If your loved one becomes more confused, anxious, restless, or agitated during the late afternoon and evening, they may be experiencing a common dementia symptom known as sundowning.
For families and carers, sundowning can be one of the most challenging aspects of dementia care. Understanding why it happens and how to respond can make evenings calmer and less stressful for everyone involved.
What Is Sundowning?
Sundowning describes a pattern where dementia symptoms become worse during the late afternoon, evening, or night.
A person living with dementia may appear relatively settled during the morning but become increasingly confused, distressed, or restless as the day progresses.
Common symptoms include:
- Increased confusion
- Repetitive questions
- Restlessness or pacing
- Irritability and frustration
- Anxiety and fear
- Hallucinations or delusions
- Wandering
- Sleep disturbances
- Wanting to “go home” even when already at home
Why Does Sundowning Happen?
There is no single cause, but several factors may contribute.
- Fatigue — living with dementia takes significant mental effort, so by evening a person may simply be exhausted, making symptoms more noticeable.
- Changes in light — as daylight fades, shadows can appear frightening or confusing, and reduced lighting may make familiar surroundings seem unfamiliar.
- Hunger or dehydration — missing meals or not drinking enough fluids can increase confusion and agitation.
- Disrupted body clock — dementia can affect the brain’s natural sleep-wake cycle, making it harder to recognise whether it is day or night.
- Overstimulation — a busy day with visitors, appointments, or excessive noise can become overwhelming.
Signs That Sundowning May Be Occurring
You may notice:
- Increased confusion after 4pm
- Repeated requests to go home
- Searching for deceased relatives
- Following family members around the house
- Becoming suspicious of others
- Increased aggression or frustration
- Difficulty settling to sleep
Keeping a diary can help identify patterns and triggers.
How to Reduce Sundowning Symptoms
Maintain a routine. Consistency helps reduce anxiety, so try to keep:
- Meal times regular
- Medication times consistent
- Bedtimes predictable
Increase daytime activity. Gentle exercise can improve sleep quality. Examples include:
- Short walks
- Gardening
- Chair exercises
- Household activities
Improve lighting. As evening approaches:
- Turn lights on before it becomes dark
- Close curtains to reduce reflections
- Minimise confusing shadows
Encourage hydration. Dehydration is a common trigger for confusion, so offer:
- Water
- Tea
- Diluted squash
- Favourite drinks throughout the day
Reduce evening stimulation. Try to avoid:
- Loud television
- Busy family gatherings
- Too much background noise
A calm environment often helps.
Provide reassurance. When someone with dementia is distressed, logic rarely works. Instead try:
- Speaking calmly
- Offering reassurance
- Validating emotions
- Redirecting attention to a comforting activity
What Not to Do
When a person is distressed, certain responses tend to make things worse. Try to avoid:
- Arguing
- Correcting repeatedly
- Telling someone they are wrong
- Forcing explanations
These approaches often increase distress.
When to Seek Professional Advice
Contact a GP or healthcare professional if:
- Behaviour changes suddenly
- Hallucinations become severe
- There is aggression causing safety concerns
- Sleep becomes extremely disrupted
- Symptoms worsen rapidly
Sometimes infections, medication changes, pain, constipation, or dehydration can make sundowning significantly worse.
Continue with the main Dementia Crisis Support.