Sundowning Syndrome: What is it and how caregivers can help

Have you ever noticed your loved one with dementia acting more confused, restless, or upset in the late afternoon or evening? Maybe they’re pacing around, talking more, seem scared, or even yell — even if they were calm all day. This is called “sundowning,” and it can be hard for both the person and the caregiver. There are ways to help.

What is sundowning?

Sundowning is a mix of confusion, anxiety, and restlessness that starts in the late afternoon and can last into the night.  

It’s not a disease — it’s a symptom, often linked to dementia, such as Alzheimer’s.

No one knows exactly why it happens, but it may be because:  

• The brain has trouble telling day from night  
• They’re tired after a long day  
• There’s less light, which can cause shadows and fear  
• They can’t communicate what they need (like hunger, pain, or a bathroom break)

It’s not on purpose. They’re not being difficult — they’re struggling.

What does sundowning look like?

Look for these changes in the late day:  

• Increased confusion or disorientation 
• Pacing or wandering  
• Yelling, crying or becoming upset more easily
• Acting anxious, scared, or angry  
• Seeing or hearing things that aren’t there  
• Wanting to “go home” even if they’re already there
• Difficulty following directions or communicating
• Difficulty sleeping or reversal of the sleep-awake cycle

These behaviors may start in the late afternoon and can last for hours into the night, making it challenging to fall asleep.

How caregivers can help

You can’t completely stop sundowning, but you can make it more manageable.  

Here are simple ways to help:

1. Keep a Calm Predictable Routine

Try to do the same things at the same time each day — meals, walks, baths, bedtime.  

The brain likes predictability, especially when it’s having trouble. Plan more stimulating activities (outings, appointments) for the morning when the person tends to feel best. Reduce activity and noise in the late afternoon and evening.

2. Light Matters

Turn on lights in the late afternoon before it gets dark to reduce shadows and confusion.  

Open the curtains during the day for natural light, but close them at dusk to minimize visual changes.  

Bright days and soft, warm lights at night can help the body know what time it is.

3. Stay Active — But Not Too Late

Encourage physical activity and exposure to natural sunlight during the day. Gentle walks, light chores, or simple games during the day can help them sleep better.  

But avoid heavy activity close to bedtime.

4. Promote Good Sleep

Discourage long or late afternoon naps or physical activity; avoid coffee, tea, or soda in the afternoon.  Keep the bedroom quiet, cool, and dark at night. 

5. Watch for Triggers

Hunger, thirst, pain, a full bladder, or even constipation can make sundowning worse.  

Check in on basic needs throughout the day, such as signs of pain, discomfort, or need to use the restroom. Offer a light snack or drink in the late afternoon.

6. Stay Calm and Reassuring

If they’re upset, don’t argue or try to reason with them. Speak softly in a gently soothing voice. Use their name calmly. Say things like: “You’re safe. I’m here. It’s okay.” Offer comfort through familiar music, a favorite blanket, or a simple calming activity. Gently redirect attention if the person becomes upset.

7. Create a Peaceful Evening Environment

Keep noise and activity low in the evening. Turn off music or switch to soft sounds. Switch off the TV, especially if it’s too loud or fast. Adding a warm drink into the nighttime routine, like herbal tea, can be soothing for you and for them. 

When to ask for help

Sundowning can be tough and even scary — feeling overwhelmed or stressed about sundowning is completely understandable.

Talk to their doctor if:  

• Sundowning symptoms are new or getting worse  
• They’re unsafe (like trying to leave the house at night or trying to hurt themselves or others)  
• Sleep problems are severe and not improving with the tips above
• You’re feeling overwhelmed or burnt out - your wellbeing matters too.

Virtual mental health care for sundowning 

A therapist or nurse can talk to you and your loved one from home — no travel, no stress.  

They can help with mood, sleep, and behavior — and give you tips and support, too. In some cases, the doctor or nurse may recommend medications to help manage severe symptoms, but non-drug approaches should always be tried first.

Sundowning is hard, but you’re not alone. And every small thing you do — a calm voice, a warm light, a quiet moment — makes a difference. Getting support for yourself helps you best support your loved one. Whether you need caregiver therapy services, training, or respite, Author Health can help find you the services you need.

Sources

1. Alzheimer’s Association. (n.d.). Sleep issues and sundowning. https://www.alz.org/help-support/caregiving/stages-behaviors/sleep-issues-sundowning
2. Mayo Clinic Staff. (2024, March 26). Sundowning: Late-day confusion. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/expert-answers/sundowning/faq-20058511
3. National Institute on Aging. (2024, July 17). Coping with agitation, aggression, and sundowning in Alzheimer’s. National Institutes of Health. https://www.nia.nih.gov/health/alzheimers-changes-behavior-and-communication/coping-agitation-aggression-and-sundowning