Dementia Care · Caregiver Guide
Sundowning in Dementia: Signs, Causes, and Caregiver Tips
As afternoon turns to evening, some people living with dementia become more confused, worried, or restless. This is often called sundowning. Learn what it looks like, why it may happen, and gentle ways to help create calmer, more predictable evenings.
8 min read
What Is Sundowning in Dementia?
Sundowning is a term used to describe increased confusion or behavioral changes that may occur later in the day in some people living with dementia. It is not a separate disease or diagnosis — it is a pattern of symptoms that may occur in some people living with dementia.
Symptoms often appear during the late afternoon, evening, or around sunset, but timing can differ from person to person. Some people experience symptoms for a short period, while others remain unsettled into the night.
Sundowning may interfere with everyday moments and routines, including:
Evening meals
Personal care
Medication routines
Bedtime and sleep
Communication
Family visits
Safety at home
Caregiver rest
Common Signs of Sundowning
Signs vary widely and should be understood as expressions of fear, fatigue, discomfort, confusion, or unmet needs — not intentional misbehavior.
Increased confusion
Anxiety and restlessness
Irritability or agitation
Pacing back and forth
Repeating questions
Calling out for someone
Difficulty recognizing familiar people
Trouble understanding where they are
Wanting to go home even when already home
Believing they need to leave for work, school, or an appointment
Following a caregiver closely
Becoming suspicious or fearful
Difficulty completing an evening routine
Resistance to bathing, changing clothes, or going to bed
Trouble separating dreams from reality
Increased wandering
Changes in sleep patterns
Waking frequently at night
Becoming more emotional or tearful
Misinterpreting shadows, reflections, sounds, or movements
These behaviors often reflect unmet needs — comfort, reassurance, rest, or safety — rather than difficult behavior. Meeting the person with patience and understanding is one of the most caring responses a family can offer.
Why Does Sundowning Happen?
There may not be one clear cause. Sundowning likely results from a mix of factors that can differ from person to person and from day to day. Understanding the possible contributors can help you notice patterns and respond with gentle support.
Possible contributing factors include:
Changes in the brain caused by dementia
Disruption to the body's internal sleep-wake cycle
Mental and physical fatigue
Low lighting
Increasing shadows
Changes in the appearance of familiar rooms after dark
Too much noise or activity
A busy household
Hunger or thirst
Pain or physical discomfort
A need to use the bathroom
Medication side effects or timing
Poor sleep
Too much daytime sleeping
Lack of daytime activity
Changes in routine
Unfamiliar people or surroundings
Overstimulation
Understimulation
Loneliness
Fear of being left alone
Difficulty seeing or hearing
Infection or illness
Dehydration
Another health issue
Sudden or severe changes should not automatically be assumed to be sundowning. If confusion appears suddenly or becomes significantly worse, please reach out to a healthcare professional — a quick check-in can help rule out other causes and give everyone added peace of mind.
How Long Does Sundowning Last?
The duration varies from person to person. Some people experience symptoms for just an hour or two, while others may remain confused or restless throughout the evening.
Symptoms may happen every day, only occasionally, or mainly during periods of stress, illness, travel, poor sleep, or changes in routine. Patterns can shift over time, so what you notice one week may look different the next.
It can help to gently keep track of when the behavior tends to begin, what was happening beforehand, and what seemed to help. Over time, these small notes can reveal comforting patterns and make each evening feel a little more predictable for both of you.
How Caregivers Can Identify Possible Triggers
One of the most helpful things you can do is keep a simple "sundowning journal." You don't need anything fancy — a notebook or a note on your phone works perfectly. Jotting down a few details each day makes it easier to spot patterns and, over time, understand what may be contributing to your loved one's evening confusion or restlessness.
Try to note things like:
The time symptoms begin
Meals and snacks
Water intake
Caffeine
Medications
Naps
Overnight sleep
Pain
Bathroom needs
Visitors
Noise
Television
Lighting
Physical activity
Changes in schedule
Appointments
Travel
Signs of illness
What the person was doing before symptoms started
What helped the person feel calmer
Example Journal Entry
3:30 p.m.
Long nap ended
4:00 p.m.
House became noisy
4:30 p.m.
Repeatedly asked to go home
5:00 p.m.
Calmed after a snack, brighter lighting, and familiar music
Noticing these patterns over time can help you and your family make small, meaningful changes to the daily routine. You don't have to solve everything at once — even a single gentle adjustment, like an earlier snack or softer evening lighting, can make a real difference and bring a little more calm to the end of the day.
Practical Ways to Reduce Evening Confusion
Small, gentle changes to the daily rhythm can make evenings feel calmer for your loved one — and for you. Explore the ideas below and try the ones that feel right for your family.
Predictable waking, meals, activities, medications, and bedtime may help reduce uncertainty. Keep the order of activities consistent even when the exact times need to change.
Schedule appointments, errands, bathing, and important conversations earlier in the day when possible. Try to avoid placing several difficult activities close together.
Turn on lamps before the room becomes dark and reduce shadows in hallways, bathrooms, bedrooms, and stairways. Close curtains or blinds if reflections cause confusion, and use night-lights where appropriate.
Lower the television volume, avoid several people talking at once, and reduce clutter. Limiting stressful news or fast-moving TV helps create a sense of calm before symptoms typically begin.
Safe walking, stretching, household activities, gardening, or music may support a healthier sleep routine. Try to avoid intense activity close to bedtime if it increases alertness.
Long, late naps may affect nighttime sleep. If sleep problems are significant, it can help to discuss them with a healthcare professional.
Offer water and a light snack before symptoms usually begin. Hunger, thirst, or dehydration may increase discomfort or confusion.
It may help to limit caffeine later in the day, including coffee, tea, soda, chocolate, and energy drinks. Every person is different, so notice what feels right for your loved one.
Consider whether something physical could be at play — pain, constipation, hunger, thirst, temperature, tight clothing, or fatigue. Also check bathroom needs, medication timing, hearing aids, glasses, or any signs of illness.
A gentle sequence might look like this: turn on lights before sunset, offer water and a light snack, play familiar music, and review the evening schedule. Then eat dinner at a consistent time, complete personal care calmly, display a reassuring message, reduce noise, prepare the bedroom, and follow a familiar bedtime routine.
Comforting, familiar activities can ease evening restlessness — folding towels, looking at family photos, listening to familiar music, watching a familiar TV program, a simple puzzle, reading together, sitting outside before dark, preparing a simple snack, talking about a familiar memory, or holding a familiar object. Try to avoid activities that are frustrating or require complex decisions.
Speak slowly and use short sentences, asking one question and giving one direction at a time. Offer two simple choices, use a calm tone, and allow extra time for a response. Repeat information without frustration, focusing on reassurance rather than correction.
What to Say During a Sundowning Episode
During an episode, try not to argue, correct every detail, or attempt to prove your loved one wrong. Instead, acknowledge the emotion first, then gently redirect their attention to something calming and familiar.
Reassuring phrases to try
You are safe. I am here with you.
Everything is okay. We can sit together.
It is evening now. Dinner will be ready soon.
You do not need to leave right now.
Let's check the schedule together.
Your appointment is tomorrow. Tonight we are staying home.
I know this feels confusing.
Let's move to a quieter room.
Would you like tea or water?
Let's look at the family photos together.
What Caregivers Should Avoid
In the moment, certain responses can heighten distress. Where possible, gently avoid the following:
Arguing
Raising your voice
Giving several instructions at once
Asking too many questions
Correcting every statement
Saying "I already told you"
Forcing the person to complete an activity immediately
Turning off lights too early
Allowing the environment to become noisy or chaotic
Introducing unexpected visitors late in the day
Changing the routine without explanation
Showing visible frustration
Using language that sounds childish or disrespectful
Safety comes first. If wandering or aggression creates immediate risk, caregivers may need to redirect, remove hazards, lock unsafe exits, or seek help right away.
Creating a Dementia-Friendly Evening Environment
Small changes to a room can make a meaningful difference. Simple environmental adjustments help reduce confusion and support calmer, more comfortable evenings.
Turn on lights before sunset
Reduce television noise
Remove clutter from walking paths
Keep familiar objects visible
Use family photos
Display the day, date, time, and evening schedule
How Visual Cues May Support Orientation
People living with dementia may benefit from seeing important information rather than relying only on verbal reminders. When key details are visible and consistent, visual cues can gently help answer the questions that so often arise throughout the day.
Common questions visual cues may help answer
What day is it?
What time is it?
Is it morning or evening?
What happens next?
Is someone coming today?
Have I taken my medication?
Where is my family?
Am I supposed to leave?
When is dinner?
What is happening tomorrow?
Clear visual information should be
Large
Easy to read
Simple
Current
Consistent
Visible from a normal sitting position
Free from unnecessary detail
Written in familiar language
How Memoryboard May Support Evening Routines
Memoryboard is a digital display designed to help families share reminders, daily schedules, appointments, photos, and messages with an older loved one. By keeping familiar information visible and consistent, it may support a dementia-friendly routine and gently reinforce what happens next — helping reduce uncertainty during the evening hours. Family members can update Memoryboard remotely from an easy-to-use app, so support can be present even when they cannot be physically in the room.
Throughout the day and evening, Memoryboard can provide visible reminders such as:
The current time
The day of the week
The date
The time of day
Upcoming appointments
Meal reminders
Medication reminders
Evening routines
Bedtime reminders
Caregiver arrival times
Family messages
Familiar photos
Reassuring notes
Simple instructions
A glimpse of an evening on Memoryboard
Tuesday, 5:12 PM
It is Tuesday evening. Dinner is at 5:30.
You are home and safe.
Maria will visit tomorrow at 10:00 a.m.
Please stay inside tonight.
Your medication is ready with dinner.
After dinner, we will watch your favorite show.
Good night, Mom. I love you.
There are no appointments tonight.
Dad will call at 7:00 p.m.
Your caregiver, Anna, will arrive tomorrow morning.
Sample messages a family might choose to show — every Memoryboard is personalized by the people who love them.
More than a dementia clock
When no other message is showing, the Memoryboard full-screen clock can display the time, date, day, and time of day in a large, easy-to-read format — which may support orientation throughout the day and evening. Unlike a basic dementia clock, Memoryboard offers a warmer, more connected experience because the very same screen can also show personal photos, daily schedules, and family messages. That means it can help families communicate from a distance and support connection when they cannot be physically present, gently reinforcing routines and reducing uncertainty about what happens next.
Bring Memoryboard Home
Example Evening Schedule for Someone With Dementia
Every person is different, but a consistent evening rhythm can ease sundowning-related confusion and anxiety. The schedule below is just one possible example of how a calm, predictable evening might unfold.
3:00 p.m.
Light snack and water
3:30 p.m.
Short walk or gentle activity
4:00 p.m.
Turn on lights and close curtains
4:15 p.m.
Quiet music or familiar activity
5:00 p.m.
Dinner reminder
5:30 p.m.
Dinner
6:00 p.m.
Family message or phone call
6:30 p.m.
Familiar television show or photo time
7:15 p.m.
Bathroom and personal care
7:45 p.m.
Bedtime reminder
8:00 p.m.
Quiet bedroom routine
This schedule is only a starting example, not a strict prescription. Adapt the timing and activities to match the person's usual habits, medical needs, personal preferences, and energy level — a routine that feels familiar and comfortable to them will always work best.
