Short answer: Sundowning is increased confusion, restlessness, anxiety or agitation that begins in the late afternoon or at dusk and can continue into the night. It is common in Alzheimer’s and other dementias, especially in the middle stages. Tiredness at the end of the day, fading light, an upset body clock and unmet needs such as pain or hunger all play a part. A calm, predictable evening routine is the most effective way to ease it.
Signs of sundowning
As the light fades, families often notice a person who was settled earlier in the day become:
- Restless, pacing or trying to leave (“I need to go home”)
- More confused about where they are or what time it is
- Anxious, irritable, suspicious or tearful
- Calling out, shadowing the caregiver, or resisting care
- Unable to settle to sleep, or awake and active at night
Symptoms usually ease by morning. Sundowning is most common in the middle stages; our guide to the stages of dementia explains where it fits.
Why sundowning happens
The exact cause is unknown, but dementia’s effect on the brain makes late-day confusion more likely, and several triggers add to it:
- End-of-day exhaustion from a full day of trying to make sense of the world.
- Fading light and shadows, which can be misread and frightening.
- A disrupted body clock that blurs day and night, often worsened by long or late naps.
- Unmet needs: pain, hunger, thirst, a full bladder, constipation or feeling too hot or cold.
- A busy household at dinner time, with noise, visitors or shift changes.
- Caffeine or alcohol late in the day, and the timing of some medicines.
How to calm someone who is sundowning
In the moment, the goal is to help the person feel safe, not to correct them. Listen calmly to their worry, then gently redirect.
| Instead of… | Try… |
|---|---|
| “You are home. Sit down.” | “Tell me about home. Shall we have some tea first?” |
| Arguing about the time or place | Acknowledging the feeling: “You seem worried. I’m here.” |
| Asking several questions at once | One simple choice: “Would you like the blue sweater or the gray one?” |
| Blocking a doorway or restraining | Walking alongside them, then guiding back to a quiet room |
Familiar music, a favorite snack, a hand massage or folding laundry together can all help the mood pass.
An evening plan that helps prevent it
- Daylight and movement: time outdoors or by a sunny window each day, and a walk or other activity.
- Short, early naps only, and the same wake, meal and bed times every day.
- Busy things earlier: appointments, outings and baths in the morning.
- A bigger lunch, a lighter supper, and no caffeine or alcohol later in the day.
- A quiet early evening: TV off, fewer visitors, curtains closed before dark, and soft lights on so there are no deep shadows.
- Needs checked before the usual difficult hour: toilet, drink, snack, pain, temperature.
- A short note of what happened just before each episode, so patterns and triggers become clear. If several people share care, pass the notes on at handover.
When to talk to the doctor
Ask for a review if sundowning is getting worse, happens every evening, disrupts nights or leaves the caregiver exhausted. The doctor can look for pain, a urinary infection, sleep apnea or constipation, and check whether any medicine, or its timing, is adding to evening confusion. If dementia medicines seem to cause side effects, our guide to donepezil side effects lists what to watch for. Our guide to dementia sleep problems covers the nights.
A daily routine families can add
Brain Vitality is a sealed fabric pouch of dry herbs, worn externally at the navel and held by a reusable belt, with nothing to swallow. In Dr. Wang’s practice records, family caregivers of older adults living with dementia described what they noticed in evening settling, sleep and daytime alertness during pouch use. These are selected, uncontrolled observations; the evidence overview explains them. Include the person in the decision, check with their doctor first, and use it alongside the evening plan above.
Questions about sundowning
What does sundowning mean?
Sundowning, also called sundown syndrome or late-day confusion, means confusion and agitation that get worse as the sun goes down. The name comes from the timing, not a disease of its own.
Can sundowning happen without dementia?
Yes. Older adults can show late-day confusion during an illness, after surgery or in the hospital. That is often delirium and should be checked by a doctor.
Does sundowning mean dementia is getting worse?
Not necessarily. It often reflects tiredness, light, routine or an unmet need on a particular day. A steady increase over weeks is worth discussing with the doctor.
Sources
Alzheimer’s Association: Sleep issues and sundowning · National Institute on Aging: Tips for coping with sundowning · MedlinePlus: Dementia, behavior and sleep problems
About the author
Qingcai Wang, MD, PhD, invented the external herbal pouch and has practiced it exclusively since 2015, so that more people can accept Chinese herbal medicine without drinking bitter herbal decoctions. His formulations draw on the classics Shang Han Lun, Jin Gui Yao Lue and Shennong Ben Cao Jing. He previously spent more than 20 years in biomedical and cancer research. He founded Five Essences, which sells the pouches
General education; ask the person’s own doctor about their care.