Memory Digest

Sundowning

Why people with dementia can become more confused, anxious or agitated in the late afternoon and evening—and practical ways to help.

Last reviewed: October 2026

Many caregivers notice that their loved one does reasonably well in the morning but becomes more confused, restless, anxious, suspicious or upset as the day goes on—often starting in the late afternoon. This pattern is called sundowning. It's common in the middle and later stages of Alzheimer's Disease and other dementias, and it can be exhausting for everyone. The good news is that small changes often help.

What sundowning looks like

• Increased confusion or disorientation
• Restlessness, pacing, or wanting to "go home" even when at home
• Anxiety, irritability, yelling or crying
• Suspicion or seeing things that aren't there
• Shadowing (following the caregiver everywhere)
• Trouble settling or sleeping at night

Why does it happen?

The exact cause isn't known, but likely contributors include:

• Body clock disruption – dementia damages the brain's internal clock that regulates sleep and wake cycles.
• Fatigue – mental and physical tiredness builds through the day.
• Fading light and shadows – which can be confusing or frightening and cause misperceptions.
• Too much or too little activity – overstimulation, or boredom and long naps.
• Unmet needs – hunger, thirst, pain, needing the bathroom, being too hot or cold.
• Caregiver stress – people with dementia often pick up on stress and tension around them.
• Medical problems – infections (such as urinary tract infections), constipation, medication effects, or untreated depression. A sudden worsening could be delirium and should be checked by a doctor.

Practical tips

During the day

• Get morning light. Open curtains, sit by a window, or go outside early in the day.
• Keep active. Walks, chores, music and outings in the morning and early afternoon.
• Limit naps to a short rest earlier in the day.
• Plan the hardest tasks—bathing, appointments—for the person's best time of day, usually the morning.
• Cut back on caffeine and sugar, especially after lunch, and avoid alcohol.

As evening approaches

• Turn the lights on before dusk and close curtains to reduce shadows and reflections.
• Create a calm routine: quiet music, a familiar TV program, a simple snack, a warm drink without caffeine, hand massage, looking at photos.
• Reduce noise and clutter; limit visitors and busy activities late in the day.
• Serve a lighter evening meal and a bigger lunch.
• Keep the same bedtime routine every night.

When sundowning happens

• Stay calm. Use a low, reassuring voice. Your calm helps theirs.
• Don't argue or try to reason about whether they are "home." Respond to the feeling: "You want to go home. Tell me about your home." Then gently redirect.
• Check for needs: pain, hunger, thirst, toilet, temperature.
• Offer a distraction: a favorite song, a simple task like folding towels, a walk around the house.
• Keep a log of when episodes happen and what came before. Patterns can reveal triggers.

At night

• Use night lights in the bedroom, hall and bathroom to prevent falls and confusion.
• Make sure the home is secure if the person may wander. See Home Safety.
• If the person wakes up, calmly reassure them and avoid turning on bright lights.

What about medicine?

Talk to the doctor if sundowning is severe, new or getting worse. The doctor can look for medical causes, review medicines, and treat pain, depression or sleep disorders. Sleeping pills and antipsychotics can increase confusion, falls and other risks in people with dementia and are generally used only when other approaches haven't worked and the benefit outweighs the risk. Melatonin has mixed evidence.

Take care of yourself

Sundowning often hits when caregivers are most tired. Ask family or friends to take over in the evening when possible, use respite services, and talk to others who understand. See Caregiver Stress and Burnout. The Alzheimer's Association Helpline (800-272-3900) is available 24/7, including evenings.

Sources

1. National Institute on Aging: Tips for Coping With Sundowning
2. Alzheimer's Association: Sleep Issues and Sundowning
3. Mayo Clinic: Sundowning: Late-day confusion

Not medical advice. This article is general information, not a diagnosis or treatment plan for any individual. Talk with a doctor about your situation.

Related articles

• Stages of Dementia
• Sleep and Memory
• Communicating with Someone with Dementia
• 10 Early Warning Signs of Alzheimer's and Dementia