Copy of Supporting Someone With Sundowning: Practical Strategies for Calmer Evenings

Practical Strategies That Support Comfort, Routine, and Connection

For many families caring for someone with dementia, the late afternoon and evening can become the most challenging part of the day.

A person who seemed calm in the morning may suddenly become restless, anxious, confused, or agitated as daylight fades. They may pace the house, ask to "go home," become suspicious, resist care, or have difficulty settling down for the evening.

These changes are commonly referred to as sundowning or late-day confusion.

Although researchers are still learning exactly why sundowning occurs, it's a very real experience for many individuals living with Alzheimer's disease and other forms of dementia.

The good news is that many care partners find success by making practical changes to the environment, daily routine, and communication style. While there is no single solution, non-drug approaches are often recommended as the first line of support.

What Is Sundowning?

Sundowning isn't a disease.

It's a pattern of behaviors that tend to appear later in the day.

Symptoms may include:

• Increased confusion

• Restlessness or pacing

• Anxiety

• Irritability

• Repetitive questions

• Wanting to leave

• Difficulty recognizing familiar surroundings

• Shadowing a care partner

• Trouble sleeping

Not everyone experiences sundowning, and those who do may experience it differently.

Understanding what triggers these behaviors is often the first step toward reducing them.

Why Does It Happen?

There isn't one single cause.

Instead, several factors may contribute:

• Fatigue after a full day

• Changes in natural light

• Hunger or dehydration

• Pain or physical discomfort

• Overstimulation

• Boredom or inactivity

• Changes in routine

• Difficulty interpreting shadows or reduced lighting

• Disruption of the body's internal clock (circadian rhythm)

  
  

Often, several of these factors occur at the same time.

When to Seek Medical Advice

Do not assume sudden or unusually severe confusion is sundowning. New or rapidly changing behavior can signal pain, infection, medication effects or another medical problem. Contact the person’s healthcare provider promptly rather than waiting several days to identify a pattern.

Start by Looking for Patterns

Before trying to change anything, spend a few days observing.

Ask yourself:

• What time do behaviors begin?

• What happened during the previous hour?

• Was the environment noisy?

• Did they skip a meal?

• Are they tired?

• Has anything changed in the routine?

  
  

Keeping a brief journal often reveals patterns that aren't obvious in the moment.

Maintain a Predictable Routine

People living with dementia often feel more secure when they know what to expect.

Try to:

• Wake up at the same time each day.

• Eat meals on a consistent schedule.

• Plan appointments earlier in the day.

• Encourage activity during the morning and early afternoon.

• Begin winding down before evening.

Familiar routines reduce uncertainty and can help make transitions feel less stressful.

Let There Be Light

As daylight fades, shadows can become confusing.

• Increase lighting throughout the home before sunset.

• Open curtains while daylight remains.

• Use warm indoor lighting to reduce dark corners and heavy shadows.

  
  

Sometimes simply brightening a room can make it feel safer and easier to interpret.

Don't Forget the Basics

Behavior is often communication.

Someone may not be able to tell you they are:

• Hungry

• Thirsty

• In pain

• Too hot

• Too cold

• Constipated

• Tired

Checking these basic needs first can sometimes resolve behaviors that appear to come "out of nowhere."

Meaningful Engagement Before Evening

Meaningful daytime engagement may help support a more comfortable evening.

This doesn't mean staying busy every minute.

It means providing opportunities for movement, conversation, creativity, and sensory experiences that are enjoyable and failure-free.

Many care partners find that activities involving the hands—sorting, arranging, manipulating soft sensory objects, folding towels, gardening, baking, or simple household tasks—help provide purpose and reduce long periods of inactivity.

The goal isn't to distract someone.

It's to help meet emotional, sensory, and social needs before stress begins to build.

Simplify the Environment

Late in the day, the brain may have more difficulty processing information.

• Too much television.

• Multiple conversations.

• Background noise.

• Cluttered spaces.

• Busy patterns.

All of these can increase confusion.

Creating a quieter, calmer environment often helps reduce overstimulation.

Reassurance Works Better Than Correction

If someone insists they need to "go home," arguing rarely helps.

Instead of correcting them, respond to the feeling behind the words.

• "I can see you're worried."

• "Tell me about home."

• "Let's sit together for a few minutes."

  
  

Acknowledging the person’s feelings may be more reassuring than correcting them.

Support the Care Partner, Too

Sundowning can be exhausting.

If you're caring for someone experiencing these behaviors, remember that your own well-being matters too.

• Take breaks when possible.

• Accept help from family and friends.

• Join a support group.

• Speak with your healthcare provider if behaviors become difficult to manage or create safety concerns.

You don't have to do it alone.

Every Day Is Different

One of the most important things care partners learn is that what works today may not work tomorrow.

That's okay.

Flexibility is part of person-centered care.

Rather than searching for one perfect solution, continue observing, adjusting, and responding to the individual's changing needs.

Small changes often make a meaningful difference over time.

Looking Beyond Sundowning

Sundowning reminds us of an important truth:

Behavior is rarely random.

It is often communication.

When we respond with curiosity instead of frustration, we begin to see the person behind the behavior.

Sometimes they need reassurance.

Sometimes they need rest.

Sometimes they need better lighting, a snack, or a quiet moment.

Sometimes they simply need something meaningful to do with their hands.

Understanding those needs doesn't eliminate every difficult evening.

But it often helps make those evenings calmer, more comfortable, and more connected.

Key Takeaways

• Sundowning is a pattern of late-day confusion experienced by many people living with dementia.

• There is no single cause, but fatigue, changes in lighting, unmet physical needs, and overstimulation may contribute.

• Consistent routines, good lighting, meaningful daytime engagement, and validation can often help reduce stress.

• Non-drug approaches are generally recommended as the first step, with medical guidance when needed.

• Every individual is different, so observation and flexibility remain essential.

  
  

References

• Alzheimer's Association. Late-Day Confusion (Sundowning).

• National Institute on Aging. Coping With Agitation, Aggression, and Sundowning.