Sundowning in dementia: understanding and easing difficult evenings

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 in dementia?

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:

• More confusion in the late afternoon or evening; there is no fixed start time
• 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.

What can I try when an evening becomes difficult?

1. Approach gently, introduce yourself if needed, and give the person space. Ask one short question at a time and allow time for an answer.
2. Notice the feeling before correcting the facts. If they want to go home, try: “You sound worried. I’m here with you.” Ask what would help them feel comfortable.
3. Check everyday needs: pain, needing the toilet, hunger, thirst, feeling too hot or cold, or uncomfortable clothing. Do not assume every change is dementia.
4. Offer a quieter, comfortably lit place. Reduce television noise and confusing reflections, without moving the person somewhere unfamiliar unnecessarily.
5. Offer one familiar choice, such as sitting together, a favourite song or a short walk together if safe. If an activity increases distress, stop and try something gentler.
6. If they need to move, allow safe movement rather than arguing or forcing them to sit. Stay nearby if needed and ask another trusted person for support if you feel overwhelmed.

Does sundowning happen every evening?

Not necessarily. Some people never experience it, and the pattern can vary from day to day. Notice what is different for this person rather than expecting a difficult evening. A brief note of sleep, meals, pain, activities and when distress begins can help you and their healthcare team look for patterns. It is not a way to diagnose the cause.

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

Sudden confusion or a marked change over hours or days needs urgent medical assessment, even if it happens in the evening. It can have causes such as illness or a medicine-related problem and should not simply be labelled sundowning. Seek emergency help if the person is in immediate danger or seriously unwell. For recurring evening distress, ask their healthcare team to review pain, sleep, medicines and other possible causes. Do not start sleep medicines or change prescribed doses without professional advice.

Talk to Hugo inside The Dementia Assistant

Continue with the main Dementia Crisis Support.