Managing Sundowning in Dementia

Sundowning, increased confusion, agitation, or restlessness in the late afternoon and evening, affects up to two-thirds of people with moderate-stage dementia. It is exhausting for families and triggers many of the most difficult care moments. Here is what helps.

Why it happens

The exact cause is not fully understood. Likely factors: disruption of the body's circadian rhythm, accumulated fatigue from the day's cognitive demands, low light triggering disorientation, and undertreated pain or unmet needs the person cannot articulate.

Environmental adjustments

Increase ambient light in the late afternoon, open blinds, turn on lamps before sunset. Reduce visual clutter and television noise. Maintain a consistent daily schedule. Minimise late-day appointments or visitors.

Medical considerations

Pain, urinary tract infections, constipation, and dehydration can all amplify sundowning. A clinical review is often the most useful single intervention. We coordinate with primary care to rule out treatable causes.

Caregiver approach

Calm, low-arousal interaction. Avoid arguing or correcting. Validate emotions, 'You seem worried; I'm here with you.' Redirect to a comforting activity if engagement is possible. Sometimes the best response is quiet presence.

When professional help becomes essential

If sundowning is putting the person or caregiver at risk, escalating despite environmental changes, or making sleep impossible, it is time for professional support. A trained dementia caregiver during the late afternoon and evening is often transformative for the family.