Understanding Sundowning: Why Evenings Can Be Harder for People With Dementia

Many families notice the same thing before they have a name for it. Mum is settled and herself all morning, then somewhere around late afternoon she becomes restless, anxious, or convinced she needs to be somewhere else. It has a name: sundowning. Knowing that it's real, common and often manageable can take a lot of the fear out of it.

What sundowning is

Sundowning describes distress, agitation or confusion that shows up in the late afternoon or evening in someone living with dementia. The Alzheimer's Society is careful to point out that it isn't necessarily tied to the sun actually setting, or limited to the end of the day. It most commonly appears in the middle and later stages of dementia, and it can include pacing, repeated questions, frustration, and in some cases hallucinations or delusions.

It isn't a deliberate behaviour, and it isn't a sign that someone is being difficult. It's a symptom, and it usually means something is unsettling them.

Why it happens

There isn't one single cause. The Alzheimer's Society lists several that can contribute, and often more than one is at play at the same time:

This is why the same behaviour can need very different responses from one person to the next. As the Alzheimer's Society puts it, each problem may need a different treatment.

What tends to help

Meet the need behind the behaviour. The first question worth asking is whether something is unmet: are they hungry, in pain, too warm, needing the toilet? Behaviour that looks like agitation is often the only way someone can say so.

Get the light right. Plenty of natural light and outdoor time earlier in the day helps. As dusk approaches, close the curtains and turn on soft, even lighting so the room doesn't fill with shadows. Covering a television that's switched off can help too, since dark screens reflect confusing shapes.

Keep the late afternoon calm. Try to move noisy tasks, busy visits and big decisions to earlier in the day, and keep the hours before evening low-key and predictable.

Use familiar comforts. A favourite piece of music, an old photograph, a warm drink or a gentle hand massage can settle someone far better than trying to reason with them.

Join their reality rather than correcting it. If someone is convinced they need to collect the children from school, arguing rarely helps. Acknowledge the feeling, then gently steer towards something calming.

The Hale Place team put it this way:

"Sundowning is one of the things families are most frightened by, partly because it can seem to come from nowhere. What we see is that it rarely does. There's almost always something in the day that has built up, and the more closely you know a person, the sooner you can spot it and soften it before the evening arrives."

Building an evening routine that works

Predictability is one of the most useful tools you have. Doing the same things in the same order each evening, a warm drink, the same music, the same bedtime steps, gives someone a sense of what comes next at a time of day when the world can feel unfamiliar. Try to keep caffeine and sugary snacks to earlier in the day, and let a large meal fall at lunchtime rather than late in the evening, so that the body isn't working hard just as it is trying to settle.

A short walk or some time outside in the afternoon, even just sitting by an open door, is worth building in where you can. Daylight and gentle movement both support a healthier sleep and wake cycle, which tends to make evenings smoother.

Looking after yourself when evenings are hard

If you're caring for someone at home, sundowning can be exhausting, particularly when it disrupts your own sleep. Try not to take it personally, and give yourself permission to ask for help. A regular break, whether that's a friend stepping in for an evening or a few days of respite, can make the difference between coping and burning out. Nobody is supposed to manage this entirely alone.

When to speak to a GP

If sundowning appears suddenly, or gets noticeably worse, it's worth mentioning to a GP. A sudden change in behaviour can be caused by something treatable, such as an infection, pain, constipation or a change in medication, and that's worth ruling out before assuming it's simply the dementia progressing.

How a specialist home approaches evenings

Evenings are one of the reasons families sometimes find home care harder to sustain. A carer who has been looking after someone all day is tired just when the most support is needed. In a specialist dementia care home, evenings are planned for rather than endured. That means a quieter late afternoon, softer lighting, fewer changes of face, unhurried meals, and staff who know each resident well enough to recognise their own early signs of restlessness and respond before it escalates.

It also means the daytime does its part. Time outdoors, gentle movement and meaningful activity earlier in the day all help people wind down more naturally when the evening comes.