Understanding Sundowning and How to Support Your Loved One

Caring for a loved one with dementia or Alzheimer’s disease can bring many emotional and practical challenges. One of the most difficult experiences for families and caregivers is noticing changes in behavior that often happen during the late afternoon or evening hours. A loved one who was calm and comfortable earlier in the day may suddenly become confused, anxious, restless, or upset as the day comes to an end.

This experience is commonly known as sundowning. While it can be overwhelming to witness, understanding what sundowning is, why it happens, and how to respond can help families create a safer, calmer, and more supportive environment for their loved ones.

What Is Sundowning?

Sundowning is a group of behavioral and emotional changes that may occur in people living with dementia, Alzheimer’s disease, or other memory-related conditions. It is not a disease itself, but rather a pattern of symptoms that can appear later in the day, usually during the late afternoon, evening, or nighttime.

A person experiencing sundowning may become more confused or have difficulty understanding their surroundings. They may also experience changes in mood, increased anxiety, or behaviors that are different from their usual personality.

Common signs of sundowning may include:

• Increased confusion or difficulty recognizing familiar people or places
• Anxiety, fear, or sudden emotional changes
• Irritability, frustration, or agitation
• Restlessness, wandering, or pacing
• Repeating questions or statements
• Increased suspicion or feeling unsafe
• Difficulty communicating thoughts or needs
• Changes in sleeping patterns or trouble settling down at night

Sundowning does not look the same for everyone. Some individuals may experience mild changes, while others may have more noticeable episodes that affect daily routines and family interactions.

Why Does Sundowning Happen?

The exact reason sundowning occurs is not fully understood, but several factors may contribute to these changes.

Changes in the Body’s Internal Clock

The brain helps regulate the body’s sleep-wake cycle, also known as the circadian rhythm. Dementia can affect the brain’s ability to manage this internal clock, making it harder for a person to understand changes between daytime and nighttime.

As daylight decreases, some individuals may become more confused or unsettled because their brain has difficulty adjusting to the transition.

End-of-Day Fatigue

A full day of activities, conversations, and stimulation can be tiring for someone with dementia. As the day progresses, fatigue may make it more difficult to process information, communicate clearly, or manage emotions.

Even simple tasks that were manageable earlier in the day may become more challenging in the evening.

Changes in Lighting and Environment

Dim lighting and shadows can affect how a person with dementia sees and interprets their surroundings. Familiar rooms may appear different, which can create fear or confusion.

Keeping spaces well-lit and reducing shadows can help make the environment feel safer and more familiar.

Unmet Physical Needs

Sometimes what appears to be sundowning may be a response to an unmet need. A loved one may become restless because they are experiencing:

• Hunger or thirst
• Pain or discomfort
• A need to use the bathroom
• Feeling too hot or cold
• Fatigue or lack of sleep

Identifying and addressing these needs may help reduce distress.

How Caregivers Can Help Manage Sundowning

While sundowning cannot always be completely prevented, caregivers can take steps to reduce triggers and provide comfort.

Maintain a Consistent Daily Routine

People with dementia often feel more secure when their day follows a familiar pattern. Try maintaining consistent times for:

• Meals
• Medication reminders
• Activities
• Rest periods
• Bedtime routines

A predictable schedule can reduce confusion and provide a greater sense of comfort.

Encourage Daytime Activities

Keeping your loved one engaged during the day can support better sleep and reduce restlessness in the evening.

Helpful activities may include:

• Short walks
• Gentle stretching or exercise
• Listening to music
• Looking through family photos
• Simple hobbies or familiar tasks

Activities should be enjoyable and matched to their abilities.

Create a Calm Evening Environment

As the evening approaches, focus on creating a peaceful atmosphere:

• Turn on lights before it becomes dark
• Reduce background noise and distractions
• Limit stressful conversations
• Play calming music if they enjoy it
• Keep familiar objects nearby
• Follow comforting bedtime routines

A calm environment can help reduce anxiety and confusion.

Avoid Overstimulation

Too much activity later in the day can increase stress. Large gatherings, loud television, multiple conversations, or unfamiliar situations may make symptoms worse.

Allow your loved one time to relax and transition into the evening.

Respond With Patience and Reassurance

During a sundowning episode, trying to correct, argue, or convince someone that they are wrong may increase frustration. Instead:

• Speak calmly and gently
• Offer reassurance
• Validate their feelings
• Redirect their attention to a familiar activity
• Provide comfort through a calm presence

Remember that the behavior is often a result of confusion or changes in the brain, not intentional actions.

When Should Families Seek Help?

While sundowning can be a common experience among individuals with dementia, sudden or severe changes should not be ignored.

Families should speak with a healthcare professional if their loved one experiences:

• A sudden increase in confusion or agitation
• Major changes from their usual behavior
• New symptoms that appear unexpectedly
• Signs of pain, illness, or infection
• Changes after starting or adjusting medications

Sudden behavioral changes may sometimes be related to other health concerns and may require medical attention.

Supporting Your Loved One Through Sundowning

Caring for someone experiencing sundowning requires patience, understanding, and compassion. Although these moments can be challenging, the right support and approach can help your loved one feel safer and more comfortable.

Every person’s experience with dementia is different. Caregivers may need time to discover which routines, activities, and calming techniques work best for their loved one.

For families providing care at home, additional support can also help reduce caregiver stress while ensuring their loved one receives consistent attention, companionship, and assistance with daily needs.

At Archangel Care Services, we understand the challenges families face when caring for a loved one with memory-related conditions. Our compassionate caregivers provide personalized in-home care focused on safety, comfort, dignity, and independence, helping seniors continue living safely and confidently at home.