What Is Sundowning in Dementia? Signs, Causes and How to Help

As afternoon turns to evening, something shifts. A person who was calm at lunchtime becomes restless, tearful or suspicious. Suddenly, they want to go home. Except they’re already home. Family carers often describe it as watching someone change right in front of them, and most of the time, they’ve no idea why it’s happening or what to do about it.

So what is sundowning in dementia? It’s a pattern of increased confusion, agitation and anxiety that develops in the late afternoon or evening in people living with dementia. Not a separate illness. Just a recognised set of behavioural changes, tied closely to the time of day.

Recognising sundowning for what it is makes a real difference. Once you understand the pattern, you can start looking for triggers, adjusting routines, and responding with a bit more confidence. Let’s get into the signs, what tends to cause it, and what actually helps.

What is Sundowning in Dementia Actually Mean?

Sundowning is also known as sundown syndrome, or sometimes late-day confusion. It describes behavioural and psychological symptoms that emerge, or get worse, as daylight fades. Often it carries on into the evening or night. It can affect anyone with dementia, though it’s most associated with Alzheimer’s disease.

You won’t find it on a medical chart as a formal diagnosis. It’s a term carers, nurses and families use because the pattern is so consistent it needed a name of its own. Studies suggest it affects somewhere between one in five and two in three people with dementia, depending on the stage and type involved.

Dementia Awareness Training

Enrol Now

It looks different from person to person, too. Quiet withdrawal and tearfulness for some. Pacing, shouting, or trying to leave the house for others. What ties it together is the timing, symptoms reliably showing up around the same point each day.

What Are the Signs of Sundowning?

The clearest sign is a shift that tracks with the time of day, rather than anything specific that happened. Someone might seem perfectly settled in the morning, then grow agitated, confused or fearful as the afternoon wears on.

Restlessness and pacing are common. So is a jump in confusion about where they are, or who’s around them. Mood can swing fast, from calm to irritable to distressed within minutes, sometimes with no clear trigger at all. And some people become suspicious of familiar faces during these moments, which is hard on everyone involved.

Sleep often takes a hit too. They may struggle to settle, wake frequently, or become more alert exactly when they should be winding down. Occasionally, hallucinations or delusions appear alongside the confusion, usually further into the condition.

If you’re supporting someone through changes like these, it helps to build a broader understanding of mental health and dementia awareness in care work, rather than treating each evening as unrelated to the last.

What Causes Sundowning in Dementia?

Nobody’s fully cracked why sundowning happens. But a few explanations keep coming up. Dementia affects the parts of the brain that regulate the body’s internal clock, and once that rhythm is disrupted, evenings become a harder time of day to manage.

Fatigue plays its part. By late afternoon, someone with dementia has often used up a lot of their capacity just to process the world around them. There’s simply less left to cope with by the time evening rolls in.

Then there’s the light. As rooms dim, shadows stretch, and shapes get harder to read. A coat on a hook in daylight can look like something else entirely once the sun’s gone down.

Unmet needs matter more than people expect, too. Hunger, thirst, pain, needing the toilet- these things don’t always come out as a clear request. More often, they come out as agitation instead. Add a day that was either too stimulating or too quiet, and you’ve got a fairly reliable recipe for a difficult evening.

Symptoms of Sundowning vs General Symptoms of Dementia

Sundowning has its own shape, and the table below shows how the symptoms of sundowning and general symptoms of Dementia differ side by side.

Sundowning is different because of when it happens. Someone managing fine in the morning can be far more confused or upset by early evening, often with nothing obvious triggering it. It’s the shift itself that matters, not just what the behaviour looks like. Carers who jot down when things get harder tend to spot the pattern within a week or two, sometimes sooner.

At What Stage of Dementia Does Sundowning Usually Happen?

Sundowning can occur at any stage of dementia. But it’s most commonly seen during the middle stage, when confusion and communication difficulties have deepened, yet the person’s often still active and mobile.

It can appear earlier, too. In early-stage dementia, someone may still be aware of their own memory difficulties, and that awareness alone can build frustration that intensifies later in the day. This gets mistaken for a mood problem sometimes, rather than sundowning.

Further on, there’s no fixed pattern. Some families notice it easing in the later stages. Others don’t. It varies enormously, person to person, and depends heavily on the type of dementia involved.

Anyone working through the Care Certificate will recognise this from Standard 9 on awareness of mental health, dementia and learning disability, which covers exactly these kinds of behavioural changes.

How Can Carers Manage Sundowning?

Start with routine. Keeping wake times, meals and activities fairly predictable helps reduce the disorientation that often triggers evening distress. It gives the day a shape the person can actually rely on.

Light matters more than people expect. Time outside, or even just near a window during the day, supports the body’s natural rhythm. Turning household lights on before dusk softens the transition, rather than letting the room slide into shadow unnoticed.

Worth checking for unmet needs before assuming the behaviour is purely psychological. Someone who seems agitated might just be hungry, thirsty, in pain, or needing the toilet, and sorting that out often calms things down fast.

Dementia Care Management

Enrol Now

Cut back on caffeine and daytime naps where you can. Better sleep at night usually means less fatigue the next day. A quieter evening helps too, so turn the television down and clear away extra noise and clutter if you’re able to.

Above all, calm and reassuring communication makes the biggest difference. Arguing or correcting someone mid-episode tends to escalate things. A steady tone and familiar routines will get you further than logic ever will.

Many of these approaches sit within wider dementia support. If you’re weighing up care home options, it’s worth understanding what EMI care involves for people whose needs have become more complex.

When Should You Seek Advice for Sundowning?

Not every case needs urgent attention, but a few things are worth flagging to a GP or senior colleague. Sudden onset, especially if it builds quickly rather than developing gradually, is one of them.

Signs of pain, a change in appetite, or confusion that doesn’t fit the usual pattern are also worth mentioning. Better to raise a concern early than wait and see what happens.

Safety changes things. If sundowning starts leading to wandering, aggression, or a real risk of falls, it’s time to get more support involved, whether that’s a GP, a family meeting, or a fresh look at the current care plan.

Frequently Asked Questions

Final Thought

Sundowning in dementia can feel unsettling, especially when it seems to arrive without warning. Understanding what is sundowning in dementia is helps carers recognise patterns, rather than something going wrong, and is often the first step towards feeling less overwhelmed by it.

A steady routine, good light, and a calm response to unmet needs won’t make sundowning disappear completely. But for a lot of families, they genuinely help. Small, consistent changes count for more than people expect.

And if the pattern changes suddenly, or safety becomes a concern, don’t sit with it alone. A GP or senior colleague can help you work out what’s going on, and support is there for the person you’re caring for just as much as it is for you.