Sundowning is one of the most challenging and distressing aspects of Alzheimer’s disease and dementia for both the person experiencing it and their caregivers. It refers to a pattern of increased confusion agitation anxiety and behavioral changes that typically occur in the late afternoon and evening hours — as the sun goes down — in people with dementia. Understanding what sundowning is why it happens and what can be done about it can make an enormous difference for families navigating dementia caregiving.
What Is Sundowning?
Sundowning — also called sundown syndrome or late-day confusion — is not a disease in itself. It is a cluster of symptoms that occur in people with Alzheimer’s disease and other forms of dementia characterized by a worsening of behavioral and psychological symptoms in the late afternoon and evening hours.
The term sundowning was coined because the symptoms tend to worsen as daylight fades — typically beginning in the late afternoon around 4 to 6 PM and continuing into the evening and nighttime hours. For many people with dementia the morning and early afternoon hours are relatively calm and functional — and the late afternoon and evening bring a significant deterioration in behavior cognition and emotional regulation.
Sundowning affects an estimated 20 to 45 percent of people with Alzheimer’s disease at some point during the course of their illness. It is particularly common in the middle stages of dementia and can become a major factor in the decision to move from home care to a care facility.
What Does Sundowning Look Like?
Sundowning can manifest in many different ways and the specific symptoms vary from person to person and from day to day. Common sundowning behaviors and symptoms include the following.
Increased confusion and disorientation
A person who has been relatively oriented during the day may become increasingly confused about where they are what time it is who people are and what is happening around them as the evening approaches.
Agitation and restlessness
Increased physical restlessness pacing wandering and an inability to sit still or settle down are common sundowning behaviors. The person may seem unable to relax or find comfort.
Anxiety and fearfulness
Heightened anxiety fear and emotional distress are common. The person may become convinced something bad is happening or may be frightened by shadows or unfamiliar sounds.
Irritability and mood changes
A person who has been calm and cooperative during the day may become irritable demanding suspicious or emotionally volatile in the late afternoon and evening.
Hallucinations and delusions
Some people experience visual or auditory hallucinations — seeing or hearing things that are not there — or develop false beliefs — delusions — during sundowning episodes. These experiences feel completely real to the person experiencing them.
Yelling and verbal outbursts
Loud vocalization crying out calling for family members or repeatedly asking the same questions are common during sundowning episodes.
Wandering
Sundowning significantly increases the risk of wandering — the tendency of some people with dementia to walk away from their home or care setting and become lost. Wandering at night is particularly dangerous.
Sleep disturbances
Sundowning often disrupts sleep — making it difficult for the person to fall asleep stay asleep or establishing a reversed sleep-wake cycle where the person is awake at night and sleeps during the day.
What Causes Sundowning?
The exact causes of sundowning are not fully understood but researchers believe several factors contribute.
Disruption of the internal clock
Alzheimer’s disease and other dementias damage the brain — including the areas that regulate the internal biological clock — called the circadian rhythm. The circadian rhythm normally regulates sleep-wake cycles body temperature hormone production and other biological processes according to the time of day. When the circadian rhythm is disrupted the brain loses its ability to distinguish day from night — contributing to confusion and behavioral changes in the evening.
Reduced sensory input
As daylight fades there is less light and visual stimulation — which can increase confusion and disorientation for people with dementia who depend heavily on environmental cues to orient themselves. Shadows and dim lighting can also be misinterpreted — leading to fear and hallucinations.
Fatigue
By late afternoon many people with dementia have exhausted their mental and emotional resources for the day. The cognitive effort required to navigate daily interactions and activities — which is far more demanding for a person with dementia than for a healthy person — leaves them depleted and less able to manage confusion and anxiety by evening.
Medication timing
Some medications that are taken during the day may wear off in the late afternoon — leading to increased symptoms. Others may have side effects that contribute to confusion or agitation.
Hunger and physical discomfort
Late afternoon hunger thirst pain and other physical discomforts can trigger or worsen sundowning symptoms in a person who cannot clearly communicate their needs.
Environmental factors
Environmental stressors such as too much noise too little stimulation schedule changes unfamiliar people and caregiver stress and anxiety can all contribute to sundowning episodes.
Strategies for Managing Sundowning
While there is no cure for sundowning there are many strategies that can significantly reduce its frequency and severity. Managing sundowning typically requires a combination of environmental modifications routine changes and in some cases medical intervention.
Establish and maintain a consistent daily routine
People with dementia function best with a predictable consistent daily routine. Meals activities rest and bedtime should occur at the same times each day. Avoid scheduling demanding activities or appointments in the late afternoon when sundowning is most likely to occur.
Maximize daytime light exposure
Bright light during the day — especially morning sunlight — helps regulate the circadian rhythm. Encourage outdoor walks or sitting near a sunny window in the morning. Light therapy — using a bright light therapy box — has been shown in some studies to reduce sundowning symptoms. Consider using brighter lighting indoors during the day and reducing exposure to blue light from screens in the evening.
Reduce late afternoon stimulation
As the late afternoon approaches reduce noise reduce the number of people in the environment turn off the television and create a calm quiet environment. Too much sensory stimulation in the late afternoon can trigger or worsen sundowning.
Engage in calming activities before sundowning typically begins
Schedule enjoyable calming activities for the late afternoon hours — before sundowning typically begins. Music that the person enjoyed earlier in life — gentle exercise such as a short walk — simple familiar activities such as folding laundry or looking at photo albums — and hand massage can all help reduce anxiety and agitation as the evening approaches.
Evaluate and address physical needs
Make sure the person has had adequate food water and pain relief before sundowning typically begins. Pain that goes unrecognized and untreated — which is common in people with dementia who cannot clearly communicate discomfort — is a significant trigger for behavioral disturbances including sundowning.
Reduce caffeine and sugar intake
Avoid giving the person with dementia caffeine or sugary foods in the afternoon and evening as these can increase restlessness and interfere with sleep.
Use reassurance and validation
When sundowning occurs respond with calm reassurance rather than correction or argument. Trying to convince a sundowning person that their fears or confusion are unfounded typically increases agitation. Instead validate their feelings — acknowledge that they feel upset or confused — and gently redirect their attention to something calming.
Create a safe environment
Because sundowning increases the risk of wandering and falls ensure the environment is safe. Use door alarms or door sensors to alert caregivers if the person tries to leave — remove trip hazards — use nightlights in hallways and bathrooms — and consider GPS tracking devices designed for people with dementia.
Consider medical evaluation and treatment
If sundowning is severe and significantly impairing quality of life for the person with dementia or their caregiver discuss medical options with the person’s physician. Treating underlying conditions that may be contributing — such as pain urinary tract infections sleep apnea or depression — can improve sundowning symptoms. In some cases medication may be appropriate — though medications for behavioral symptoms of dementia carry significant risks and should be used cautiously and only when non-pharmacological strategies have been exhausted.
Sundowning and Caregiver Wellbeing
Sundowning is one of the primary contributors to caregiver burnout in dementia caregiving. The late afternoon and evening hours — when sundowning is most likely — are often the hours when caregivers are most fatigued themselves. Managing a confused agitated and potentially combative person with dementia for hours every evening takes an enormous toll on caregivers’ physical and emotional wellbeing.
Caregivers of people with sundowning should take the following steps to protect their own wellbeing.
Seek respite care
Arrange for someone else to provide care during the sundowning hours periodically — whether a paid caregiver family member friend or volunteer — to give yourself a break. Even a few hours of respite on a regular basis can make a significant difference.
Join a caregiver support group
Connecting with other caregivers who understand what you are going through provides emotional support practical advice and a sense that you are not alone. The Alzheimer’s Association offers both in-person and online support groups for dementia caregivers.
Consult with the care team
Work with the person’s physician geriatrician or memory care specialist to develop a management plan for sundowning. You do not have to figure this out on your own.
Consider whether the current care setting is sustainable
Severe sundowning is one of the most common reasons families ultimately transition a person with dementia from home care to a memory care facility. Memory care facilities have staff experienced in managing sundowning and structured environments designed to minimize it. If sundowning is making home caregiving unsustainable it is worth exploring memory care options.
Key Resources
- Alzheimer’s Association — alz.org — comprehensive information on sundowning and dementia caregiving — 24/7 helpline at 1-800-272-3900
- Alzheimer’s Foundation of America — alzfdn.org — caregiver support and education resources
- Caregiver Action Network — caregiveraction.org — resources for family caregivers
- Eldercare Locator — eldercare.acl.gov — 1-800-677-1116 — connect with local memory care and caregiver support resources
The information in this article is for general informational purposes only and does not constitute medical advice. Sundowning is a complex symptom that varies significantly from person to person. Always consult a qualified physician or geriatric specialist for guidance specific to your loved one’s situation.
Last updated: July 2026