When the Sun Goes Down, Confusion Can Set In: Understanding Sundowning in Dementia

It’s late afternoon and suddenly your loved one seems restless, anxious or convinced they need to leave for an appointment that doesn’t exist. They may repeatedly ask to go home, even though they’re sitting in their own living room.

What’s going on?

It could be sundowning, a common experience among older adults living with Alzheimer’s disease and other forms of dementia.

Although these changes can be distressing, understanding what’s behind them can help you respond with patience, reassurance and practical strategies that make evenings easier.

What Is Sundowning?

Sundowning refers to increased confusion, anxiety, restlessness or agitation that typically occurs in the late afternoon or evening, as daylight fades.

According to Dementia UK, sundowning affects approximately 20% of people living with dementia. It’s more common in the middle and later stages of the disease, although not everyone experiences it.

Symptoms might stick around for a bit or last a few hours, and they don’t always show up every night.

Why Does Sundowning Happen?

There’s no single explanation. Dementia can affect the body’s internal clock, making it harder to distinguish day from night. As evening approaches, research shows several factors can contribute to confusion or discomfort:

• Fatigue: A busy day can leave someone physically and mentally exhausted.
• Changing Light: Fading daylight can make surroundings appear unfamiliar.
• Unmet Needs: Hunger, thirst, pain or needing to use the bathroom may cause distress.
• Overstimulation: Noise, visitors and too much activity can become overwhelming.
• Disrupted Sleep: Changes in sleep patterns may increase late-day restlessness.
• Medication Effects: Certain medications or changes in treatment can create confusion.

Often, several factors are involved. Identifying personal triggers is an important first step toward managing symptoms.

What are the signs?

Sundowning can look different from person to person. Common signs include:

• Increased confusion or disorientation
• Anxiety, fear or irritability
• Pacing, wandering or restlessness
• Repeated questions or requests
• Difficulty recognizing familiar people or surroundings
• Insisting it’s time to go home, work or pick up children
• Trouble settling down or sleeping

Remember, these behaviors reflect genuine fear, discomfort or an unmet need. For example, if your loved one insists they need to go home, they may be expressing a desire for safety and familiarity.

How can sundowning be reduced?

While sundowning can’t always be prevented, small adjustments can make a difference.

1. Keep the Day Predictable: Consistent times for waking, meals, activities and bedtime provide reassuring structure. Try to schedule appointments and more demanding activities earlier in the day before the individual is tired, overwhelmed, or beginning to sundown.
2. Let the Sunshine In: Natural daylight helps regulate the body’s sleep-wake cycle. Encourage a morning walk, time outdoors or sitting near a sunny window. Gentle daytime exercise may also improve nighttime sleep.
3. Get Ahead of the Shadows: Turn on lamps before daylight fades. Maintain comfortable, even lighting to reduce confusing shadows without creating harsh glare. Nightlights can help with safe movement after dark.
4. Turn Down the Volume: As evening approaches, lower the television, reduce background noise and limit busy activities. A quiet room, comfortable chair and familiar surroundings can create a more peaceful atmosphere.
5. Check the Basics: Sometimes agitation has a simple explanation. Is your loved one hungry, thirsty, uncomfortable or in pain? Do they need to use the bathroom? Offering water, a light snack or help getting comfortable may ease their distress.
6. Reassure Rather Than Correct: If your loved one insists they need to pick up the children from school, arguing about their children’s ages may increase their anxiety.

Instead, acknowledge the feeling behind the concern. Try saying, “You’re worried about the kids. They’re safe. Let’s sit together for a minute.” Speak slowly, use short sentences and offer gentle reassurance. Playing a familiar song or giving them something to do, such as folding towels, can redirect their attention.

• Look for Patterns: Keep a brief record of when symptoms occur, what happened beforehand and what seemed to help. You may discover that a particular noise, late meal or overly busy afternoon is contributing to the problem.
• Be Proactive: If you know when an individual will start to sundown, be proactive in engaging them in a meaningful low-key activity or hobby. This could be watching their favorite show, listening to records, relaxing adult coloring, hand massages, or simple conversation.

These observations also help healthcare professionals recommend appropriate strategies.

When Should You Call a Healthcare Professional?

Don’t automatically assume new or worsening confusion is sundowning.

Sudden behavioral changes can also point to infections, dehydration, medication reactions, pain or delirium, which may require prompt medical attention.

Contact a healthcare professional if symptoms appear suddenly, become more severe or interfere with safety. Seek urgent medical evaluation for abrupt, significant confusion or other concerning acute symptoms.

A healthcare professional can evaluate possible medical causes and discuss treatment options.

How Can I Offer Support?

Caring for someone experiencing sundowning can be emotionally exhausting, especially when difficult evenings happen regularly.

Give yourself permission to ask for help. Share caregiving responsibilities, take breaks when possible and remember that every evening won’t unfold the same way.

For families exploring memory care, ask how a community responds to late-day confusion, creates reassuring routines and supports residents through challenging moments.

Capri Communities’ Blu Grotto Memory Care makes each day meaningful and comfortable, including the moments when someone needs extra patience, understanding and reassurance.

Because the most important thing you can offer someone living with dementia is a calm voice, a familiar presence and the comfort of knowing they’re not alone.