Dementia often reveals itself through quiet, easy-to-miss changes in memory, language, or mood that many people brush off as normal aging. Yet one particular pattern stands out because it follows a remarkably consistent schedule, typically worsening in the late afternoon and early evening. Experts refer to this as sundowning, a phenomenon where confusion, restlessness, and other challenging behaviors intensify as daylight fades. Recognizing this timing can be an important clue for families wondering whether a loved one’s shifting evening mood signals something more serious.
Dr. Kellyn Lee, who leads a prominent dementia charity, has highlighted sundowning in her public explanations, noting that while it can occasionally appear at other times, it most reliably surfaces in the afternoon or evening for those living with dementia. People experiencing it may suddenly become anxious, irritable, or deeply confused. Some pace restlessly, others grow suspicious or agitated, and a few even report seeing or hearing things that aren’t there. These episodes can stretch into the night, making restful sleep difficult for both the person with dementia and their caregivers.
Although sundowning tends to appear in the middle and later stages of the illness, researchers still don’t fully understand why it happens. The Alzheimer’s Association points to several common triggers that can spark or intensify the symptoms. Fatigue that builds up over the day, unmet needs like hunger or pain that the person struggles to express, and lower light levels as evening approaches all play a role. Too little natural sunlight during daytime hours or too much noise and activity can also set the stage for evening distress.
Brain changes in dementia disrupt the body’s internal clock, which normally helps us feel alert by day and sleepy at night. Shifting hormone levels throughout the afternoon and evening add to the challenge. Sensory difficulties, such as reduced vision or hearing, make familiar surroundings feel strange or threatening once shadows lengthen. Even caregiver tiredness toward the end of the day can unintentionally heighten a loved one’s unease.
Certain environmental factors deserve attention too. Dim or uneven indoor lighting as the sun sets can create confusing shadows that fuel anxiety. Some people become more unsettled when routines shift in the evening, such as reduced staffing in care facilities or changes in household activity. Medications taken earlier in the day sometimes contribute as their effects wear off.
Families can often ease sundowning by addressing these triggers thoughtfully. Encouraging bright natural light exposure during morning and afternoon hours helps reinforce the body’s daily rhythm. Keeping evenings calm and predictable, with soft activities and minimal stimulation, tends to reduce agitation. Simple adjustments like closing curtains early to block fading outdoor light and turning on steady indoor lamps can prevent disorienting shadows.
Paying close attention to physical comfort matters enormously. Regular meals, gentle reminders to use the bathroom, and prompt attention to any signs of discomfort can prevent small issues from escalating. A short afternoon rest, without allowing long naps that disrupt nighttime sleep, often helps manage accumulating fatigue. When agitation rises, responding with patience and reassurance rather than correction usually calms the moment more effectively.
Spotting this evening pattern early offers families a valuable window to seek medical guidance and explore supportive strategies. Doctors can review medications, check for other health conditions that worsen symptoms, and suggest tailored approaches. Support groups and dementia organizations also provide practical ideas that have worked for others facing the same daily shift.
Have you noticed sundowning behaviors in someone you care about, or found routines that help smooth those tougher evening hours? Share your experiences and insights in the comments.
