Sundowning in dementia: causes and what helps in the evening

As daylight fades, a person with dementia may become more confused, restless, anxious or upset. They might pace, repeat questions, mistake shadows for something else or want to leave home. This pattern is often called sundowning. It can be unsettling for the person and for those supporting them, but it does not happen to everyone and it is not a predictable stage of dementia.

What sundowning can look like

Changes often happen in the late afternoon or evening, though the timing and symptoms differ. Someone may seem more alert or unsettled, have difficulty following a conversation, become irritable, or have trouble settling for the night. Some people’s behaviour changes only occasionally; for others, it happens more regularly.

Dementia itself can affect memory, perception, communication and the ability to cope with unfamiliar situations. These changes may become more noticeable as the day goes on. Sundowning alone does not show how quickly dementia is progressing, and it cannot tell you what stage someone is at. People’s needs vary, so focus on what is changing for your relative and what support helps them feel safe.

Why might it happen?

There is no single confirmed cause. Possible contributors include tiredness, changes to the body’s sleep-wake rhythm, reduced daylight, shadows or glare, too much noise, and a busy or disrupted day. It may also be harder to make sense of their surroundings when there is less light or the person is tired.

Sometimes a change in behaviour has a physical or practical cause: pain, hunger, thirst, needing the toilet, constipation, an illness, or a change in surroundings or routine. Vision or hearing difficulties can add to confusion. A new medicine or a change in how medicines are taken may also be relevant, but do not stop or change medicines without advice from a GP or pharmacist.

Try to treat a new behaviour as information, not deliberate misbehaviour. A simple record of when it happens, what came before it and what seemed to help can show patterns. The behaviour and mood log can help you share those observations with the care team.

What helps in the evening?

There is no one approach that works for everyone. Try one or two changes at a time and notice whether they make evenings easier.

• Keep the routine familiar. Aim for a predictable sequence around meals, personal care and settling for bed. Let the person know what is happening next, using short, calm phrases.
• Make the room easier to understand. Turn on lights before it gets dim, reduce glare and shadows, and keep pathways clear. Familiar objects and a visible clock or calendar may be reassuring if the person finds them useful.
• Reduce pressure and stimulation. Turn down the television, limit several people talking at once, and avoid rushing through tasks. If a task is upsetting, pause and try again later when it is safe to do so.
• Offer comfort and simple choices. Ask whether they are hungry, thirsty, uncomfortable or need the toilet. Offer a familiar snack, a warm drink if appropriate, or a quiet activity they enjoy. A choice between two options can be easier than an open-ended question.
• Respond to the feeling. If the person is worried, acknowledge that they seem unsettled and offer reassurance. Correcting them, arguing or testing their memory can increase distress. A gentle change of subject or familiar music may help.
• Support day-night cues. Daylight and suitable activity during the day may help maintain a routine. If naps or late-day activity seem linked to difficult nights, note the pattern and discuss it with a health professional rather than imposing a tiring schedule.

A daily routine plan can help family members and other carers follow a consistent approach. For broader home checks, see the home safety checklist for older people.

Safety without making the person feel restricted

If someone paces or tries to go out, consider what they may be looking for: a familiar place, a person, the toilet or simply something to do. Stay nearby if possible and guide them towards a safer activity. Keep keys and potentially hazardous items out of casual reach, improve lighting and remove trip hazards. Check that exits and routes are safe, and consider a plan for what family members will do if the person leaves unexpectedly.

Use safety measures that suit the person and the home. Avoid locking someone in or using anything that could trap them or block their escape in a fire. If wandering is a recurring concern, ask a GP, dementia specialist or local support service for advice on a personalised safety plan. In an immediate emergency, contact the emergency services.

When to contact a GP

Contact a GP or appropriate health professional if the behaviour is new, becomes significantly worse, causes distress, repeatedly disrupts sleep, or creates safety concerns. Share when the change began, how it differs from the person’s usual pattern, any other symptoms, and any recent changes in medicines or routine. A clinician can assess whether an illness, discomfort or another issue needs attention.

A sudden change in confusion or alertness needs prompt medical advice, especially if the person is much less responsive, unusually agitated or otherwise acutely unwell. Sudden confusion can have causes that need urgent assessment; do not assume it is simply dementia or sundowning. Follow local urgent-care guidance, and use the emergency services if there is immediate danger or a serious acute problem.

Looking after yourself and sharing care

Evenings can become a demanding part of the day, particularly if you are also managing work, children or overnight support. Agree who will cover which tasks, and share a short note about what has worked and what to watch for. If you are becoming exhausted or feel unable to keep the person safe, tell family, the care team or local dementia services. Ask about respite or other practical support where available.

You do not have to solve every difficult evening at once. Small adjustments, a clear record and professional advice when something changes can help you respond with patience while protecting both your relative’s wellbeing and your own.