What to Do When Sundowning Starts
Sundowning is the name for restlessness, agitation, irritability, and confusion that begin or worsen as daylight fades, and the practical response starts hours before the hard part of the evening.
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When it starts, do less: lower the light, lower your voice, and stay with them.
The word families are usually handed is sundowning, and it is worth knowing that it names a pattern in the day rather than a condition of its own. The Alzheimer's Association describes it as increased confusion that people living with Alzheimer's and other dementias experience from dusk through the night, which is why it can feel like a different person arrives at the same point in the day.
The useful detail in that description is what it is keyed to. It tracks the light going, not a number on the clock, so it moves with the season and it moves with how bright the room happens to be. A house that is fine in July can be hard at four in the afternoon in December without anything about the person having changed.
When the hour is already underway, there is not much to be gained by problem solving. The four moves below are what the moment asks for, and none of them require being right. If the part you find hardest is the last one, there is more on how to talk to someone with dementia. For the wider picture of what a day at home can look like, start with dementia care at home.
- Light
Turn the lamps on before the light goes, and keep the room bright.
Letting the room dim as the afternoon runs out.
- Noise
Lower the noise. One conversation, one thing on, or nothing on.
A television, a phone call, and two visitors at once.
- Voice
Stay calm and slow, and let the pace of your voice set the pace of the room.
Matching their agitation with your own.
- Belief
Do not argue with what the person believes is happening.
Correcting the facts until somebody wins.
The evening is decided in the afternoon
Almost everything families are told to do about sundowning happens hours before it. That is an awkward thing to hear at seven in the evening and a genuinely useful thing to know at eleven in the morning. The National Institute on Aging publishes its guidance for coping with sundowning as a short list of ordinary daily habits, and four of them do most of the work.
None of this is a treatment and none of it is a promise. It is the list the institute itself puts in front of caregivers, repeated here so that the day has somewhere to start. The reason to try them together rather than one at a time is that they share a single subject, which is how tired a person is by the time the light goes.
Being overly tired
The institute names being overly tired as something that can increase restlessness in the late afternoon and early evening. Which makes the whole shape of the day the thing worth looking at first: how early it started, how full it was, and whether there was any quiet in it before the hard part arrived.
Long and late naps
Discouraging long naps and dozing late in the day is on the same list. Rest earlier tends to cost the evening less than rest at four.
Caffeine and alcohol, late
Avoiding alcoholic drinks and caffeinated beverages such as coffee or cola late in the day is advised. The afternoon cup is the one that usually goes unnoticed, because it has been part of the routine for forty years and nobody thinks of it as late.
Daylight, on purpose
Arranging a time each day to go outside or sit by a window is recommended. On a bad week it is the one that gets dropped first, and it is the one that costs nothing.
Setting the room up before the light goes
Low lighting increases shadows, and the Alzheimer's Association notes that those shadows may cause a person living with dementia to become confused by what they see. Read the other way around, that is a small and very practical instruction: keeping the home well lit in the evening is one of the steps it lists for reducing the confusion of the late day. Not brighter at the moment things get difficult. Bright already.
In most houses that means turning on more than feels necessary, and turning it on while there is still daylight in the window, so that nothing in the room changes as the outside light drops. The corners are the part people miss. A single overhead fixture leaves the edges of a room in exactly the half light the guidance is warning about.
When to call the doctor, and who else can be there
Nothing on this page is a substitute for the physician. New, sudden, or quickly worsening confusion belongs in a call to them promptly, because a change like that can have causes that have nothing to do with dementia and some of them are treatable by a doctor. Anything that puts the person or anyone else in immediate danger is a 911 call, without waiting to see whether the evening settles.
If a person living with dementia has wandered and is not found within fifteen minutes, the Alzheimer's Association advises calling 911 to file a missing person report. Worth agreeing on before it is needed, and worth reading alongside dementia wandering and how to prevent it.
The other question families ask is quieter. The late afternoon is often the hour when one person is doing everything at once, and a second pair of hands in the house changes what the hour costs. A caregiver can be scheduled for the end of the day specifically: there to keep company, help with the meal, keep the routine steady, and supervise so nobody is alone with it. That is daily-living support, it is not a treatment for sundowning, and it does not replace a conversation with the doctor. For what a standing evening schedule looks like, see in home dementia care.
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Questions families ask
sundowning
Sundowning is restlessness, agitation, irritability, and confusion that begin or worsen as daylight fades in the late afternoon and evening. In the moment, keep the room well lit, lower noise, stay calm, and avoid arguing with what the person believes. During the day, protect against overtiredness, discourage long late naps, and skip caffeine and alcohol later on. Persistent or worsening changes belong in a call to the doctor.
What time does sundowning usually start?
It tracks fading daylight rather than a fixed clock time, so it often begins in the late afternoon or early evening and can continue into the night. The Alzheimer's Association describes it as increased confusion from dusk through night, which is why the season and the room's lighting both matter.
Does more light in the evening actually help?
It can. Low lighting increases shadows, which may cause a person living with dementia to become confused by what they see, so keeping the home well lit in the evening is a recommended step. Daytime light matters too: arranging time outside or by a window is advised as part of preventing sundowning.
When should we call the doctor about sundowning?
Raise new, sudden, or worsening confusion with the physician promptly, since changes can have causes unrelated to dementia. If a person who has wandered is not found within 15 minutes, the Alzheimer's Association advises calling 911 to file a missing person report. Any immediate danger to the person or others is a 911 call.
The hardest hour of the day is the one nobody should be alone in.
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