Sundowning: What It Is, Why It Happens, and What Actually Helps

It's 4pm. Your loved one was fine all morning — calm, engaged, maybe even cheerful. But now something has shifted. They're restless. Pacing. Asking the same question again and again. Maybe they want to "go home" even though they're sitting in the house they've lived in for thirty years.

If this pattern sounds familiar, you're likely dealing with what's commonly known as sundowning.

What is sundowning?

Sundowning refers to a pattern of increased confusion, agitation, or anxiety that tends to occur in the late afternoon or early evening. It's not a separate condition — it's a common experience for many people living with dementia, particularly in the middle stages.

The name comes from the timing: symptoms often appear as the sun goes down, though for some people it starts earlier in the afternoon.

Common signs include:

• Increased agitation or irritability
• Pacing, restlessness, or wanting to leave
• Confusion about where they are or who people are
• Repeated questions or statements
• Crying, shouting, or becoming upset
• Resistance to help with evening routines
• Insistence on "going home"

Why does it happen?

Researchers don't fully understand the causes, but several factors likely contribute:

Fatigue. By late afternoon, your loved one has been processing information, making decisions, and navigating the world all day. Even with a simple routine, this is exhausting for a brain under strain. Fatigue lowers the threshold for confusion and distress.

Light changes. Fading daylight and shifting shadows can be disorienting. Reduced light also affects the body's internal clock, which may already be disrupted.

Internal clock disruption. Dementia can affect the suprachiasmatic nucleus — the part of the brain that regulates circadian rhythm. This means the body's signals about when to be awake and when to rest become unreliable.

Hunger and thirst. If lunch was light or a long time ago, low blood sugar or dehydration can worsen confusion and agitation.

Overstimulation. A busy household in the evening — cooking sounds, TV, children arriving home, phones ringing — can overwhelm someone whose ability to filter sensory input is compromised.

Pain or discomfort. People living with dementia may struggle to communicate that they're in pain, too hot, too cold, or need the bathroom. Discomfort often shows up as agitation.

What actually helps

There's no single solution, but many families find that a combination of environmental changes, timing adjustments, and gentle strategies can reduce the frequency and intensity of sundowning episodes.

1. Start the wind-down early

Don't wait until the agitation begins. Start shifting the environment around 3pm:

• Close curtains slightly to prevent harsh slanting light
• Turn on warm, steady lamps before the natural light fades
• Lower the volume on everything — TV, radio, conversations
• Reduce the number of people in the room if possible

The goal is a gradual transition from "active day" to "calm evening" before the difficult window hits.

2. Offer an afternoon snack

A small, nutritious snack around 3:00–3:30pm can help stabilise energy:

• Toast with peanut butter
• A banana and a glass of milk
• Cheese and crackers
• A warm drink with a biscuit

This isn't about nutrition plans — it's about keeping blood sugar steady through the tricky window.

3. Use familiar, calming activities

Have a go-to activity ready for the late afternoon that requires minimal cognitive effort but provides comfort:

• Music from their era — this is consistently one of the most effective calming tools. Create a playlist of songs from when they were 15–25 years old
• Gentle movement — a short walk, gentle stretching, or simply standing by the window
• Tactile activities — folding towels, stroking a pet, handling familiar objects
• Looking at photos — particularly old family photos that connect to long-term memories

4. Keep the evening routine consistent

A consistent daily routine is especially important in the evenings. The same sequence, the same time, the same gentle pace:

• Dinner at a regular time
• A familiar activity after dinner (not stimulating TV)
• Prepare for bed with the same steps each night
• Same bedtime, same words of reassurance

5. Check for physical causes

Before assuming it's sundowning, rule out simpler explanations:

• Do they need the bathroom?
• Are they in pain? (Watch for facial grimacing, guarding a body part, changes in walking)
• Are they too hot or too cold?
• Is there a noise or visual disturbance bothering them?
• Have they had enough to drink today?

Sometimes what looks like sundowning is actually discomfort that they can't easily express.

6. Watch your own energy

This one is hard to hear, but it matters: your loved one may be picking up on your stress.

By late afternoon, you're tired too. You've been caregiving all day. Your patience is thinner, your voice might be tighter, your movements more rushed. People living with dementia are often remarkably attuned to emotional cues, even when they can't process words well.

If you can, take ten minutes for yourself before the sundowning window. A cup of tea alone. A few deep breaths. A quick phone call to a friend. This isn't selfish — it's strategic. If you're feeling the weight of caregiving building up, our article on caregiver burnout has practical steps that can help.

When to talk to the doctor

Sundowning that is new, suddenly worse, or accompanied by other changes is worth discussing with your loved one's doctor or specialist. Sometimes an underlying issue — a urinary tract infection, medication side effects, untreated pain — can mimic or worsen sundowning.

Keep notes about when it happens, how long it lasts, and what seems to help or make it worse. This information is valuable for their healthcare team.

What doesn't help

A few approaches that caregivers commonly try but that rarely improve things:

• Reasoning or correcting — "You ARE home, Mum" tends to increase frustration, not reduce it
• Sedating TV — the flickering light and sudden sounds often make things worse
• Forcing bed early — if they're agitated, putting them in a dark room alone can increase fear
• Caffeine after lunch — this can disrupt the already-fragile sleep–wake cycle
• Ignoring it — hoping it will pass sometimes works, but often the agitation escalates without gentle intervention

You're navigating something genuinely hard

Sundowning is one of the most challenging aspects of dementia care. It comes at the end of the day, when you have the least energy to deal with it. It can feel relentless.

But it does respond to adjustments. Not perfectly, not every time — but over weeks, families who implement consistent environmental and routine changes often see real improvements.

Be patient with your loved one. Be patient with yourself. And know that what you're doing — showing up, adapting, trying again — matters more than you think.

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OurTurn is a family care coordination tool — not a medical device. If you're concerned about new or worsening symptoms, always consult your loved one's healthcare team.