Quick answer
Sundowning is when a person with dementia becomes more confused, restless, anxious or agitated in the late afternoon and evening. It’s common, especially in the middle and later stages. It often eases with a steady routine, plenty of daylight, a calm evening and good lighting. A sudden change, though, can signal an infection, pain or a medication problem, and should be checked by a doctor.
It often starts around the same time every day. Your mom was fine at lunch. By four or five o’clock she’s pacing, asking to “go home” even though she’s in her own living room, or getting upset about things that didn’t bother her a few hours earlier. If that sounds familiar, you’re not imagining it, and you’re far from alone. This late-day pattern has a name: sundowning.
What Sundowning Looks Like
Sundowning isn’t a disease in itself. It’s a pattern of behavior seen in people living with Alzheimer’s disease and other dementias, where symptoms get worse as daylight fades. It can include:
- Increased confusion or disorientation
- Restlessness, pacing or wandering
- Anxiety, agitation or irritability
- Asking repeatedly to leave or “go home”
- Shouting, suspicion or seeing things in shadows
- Trouble settling down to sleep
Why It Happens
Nobody knows the exact cause, and it’s usually a mix of things. Common contributors include:
- Tiredness building up through the day
- Fading light and shadows, which can be confusing or frightening
- A disrupted body clock, often linked to dementia’s effect on sleep
- Unmet physical needs: hunger, thirst, pain, needing the bathroom, or being too hot or cold
- Too much noise or activity in the evening, like busy households, TV or visitors
- Medications and infections, which are easy to miss (more on that below)
Does Sundowning Mean Dementia Is Getting Worse?
This is one of the most common worries families search for. Sundowning is more common in the middle and later stages of dementia, so its appearance can reflect how the condition is progressing. But it doesn’t automatically mean a rapid decline, and many families find it improves with the right changes.
What matters most is how quickly it changes. If evenings have become noticeably worse over just a few days, don’t assume it’s the dementia. A sudden change can be delirium, a temporary state of severe confusion caused by something treatable, such as:
- A urinary tract infection (very common in older adults, often without typical symptoms)
- Other infections, dehydration or constipation
- Pain that the person can’t explain
- A new medication or a dose change, particularly sleep aids, some allergy medicines, bladder medicines, strong painkillers and anxiety medicines
When to Call the Doctor
Contact the doctor promptly if:
- Confusion or agitation has worsened suddenly, over hours or days
- There’s fever, pain, burning on urination, or a change in eating or drinking
- Symptoms started after a new medication or dose change
- Your parent might hurt themselves or others, or is trying to leave the house at night
- You’re no longer coping. Your health matters too.
A pharmacist’s tip: ask the doctor or pharmacist for a full medication review. Some medicines commonly used in older adults can worsen confusion, and timing matters too. A medication given in the evening might be better in the morning, or not needed at all. Never stop or change a medicine without advice.
What Helps: Everyday Changes
Keep a steady daily routine. Meals, activities, bath time and bedtime at about the same time every day give the brain predictable cues.
Get daylight and activity earlier in the day. A morning walk, time by a sunny window, or a simple outing helps set the body clock and makes evening tiredness more natural.
Limit long daytime naps, and avoid caffeine and alcohol later in the day.
Make evenings calm. Lower the noise, turn off busy TV programs, and save visitors and errands for the morning. Soft music, folding laundry, looking at photos, or a simple puzzle can help settle restless hands.
Light the house before it gets dark. Turn on lamps early and close curtains at dusk, so the change from day to night is less jarring and shadows are reduced.
Check basic needs first. Before assuming it’s “just the dementia,” ask: Is she hungry, thirsty, in pain, too cold, or does she need the bathroom?
Respond to feelings, not facts. If your dad wants to “go home,” arguing rarely helps. Reassure him (“You’re safe, I’m here”), then gently redirect to something calming.
Prepare for the Clock Change
When daylight saving time ends in early November, darkness suddenly arrives an hour earlier, and many caregivers notice sundowning gets harder for a few weeks. In the days around the change, keep routines especially steady, turn lights on earlier, and plan quiet evenings.
Products That Can Help
No product cures sundowning, but a few simple tools can make evenings easier and safer:
Day and Date Dementia Clock
Shows “Monday Evening” and the full date in plain words, which helps with orientation as the light fades and reduces repeated questions about the time.
- Night lights reduce shadows and confusion at dusk and overnight. See our motion-sensor night light guide.
- Dementia clocks clearly show whether it’s morning, afternoon or evening. See our dementia clock guide.
- Simple activities such as large-piece jigsaw puzzles can calm restless hands in the late afternoon.
- Bed exit alarms alert you if your parent gets up at night. See our bed alarm guide.
- GPS trackers give peace of mind if evening restlessness leads to wandering. See our GPS tracker guide.
Look After Yourself, Too
Sundowning is exhausting, because it arrives just when caregivers are tired themselves. If you can, arrange for someone else to help in the late afternoon a few times a week. The Alzheimer’s Association 24/7 Helpline (1-800-272-3900) offers free advice any time of day or night. Our guide to caregiver burnout covers getting support before you reach your limit.
Frequently Asked Questions
What time of day does sundowning start?
Usually in the late afternoon or early evening, often as daylight starts to fade, and it can continue into the night.
Is sundowning a sign that dementia is getting worse?
It’s more common in the middle and later stages, but it doesn’t necessarily mean rapid decline. A sudden worsening should be checked by a doctor, because infections, pain and medications can all cause it.
Can a urinary tract infection cause sundowning to get worse?
Yes. In older adults, a UTI can cause sudden confusion or agitation, sometimes without the usual symptoms. If behavior changes quickly, ask the doctor to check for infection.
How can I calm someone who is sundowning?
Stay calm and reassuring, check for hunger, pain, thirst or needing the bathroom, reduce noise and shadows, and gently redirect to a soothing activity rather than arguing.
This article provides general information and is not medical advice. Always talk to your loved one’s doctor about changes in behavior or medication. This page contains affiliate links. As an Amazon Associate (website0079-20) I earn from qualifying purchases. See our Affiliate Disclosure.