Sundowning in dementia: what it is and what helps

By James editorial team, Golan Europe S.L. · Published 1 November 2026 · 8 min read

Sundowning is when a person with dementia becomes more confused, restless or upset in the late afternoon and evening. It is common and it is not their fault. What helps most is a steady daily routine, daylight and activity earlier on, a calm and well-lit home as it gets dark, and a quiet voice in the moment. If the change is sudden or new, call a doctor.

What sundowning looks like

The word comes from the time of day. As the light fades, some people with dementia change. MedlinePlus, the US National Library of Medicine's health site, describes problems that get worse "when it gets dark at the end of the day and into the night"^[1].

You might notice some of these:

• pacing, wandering from room to room, or trying to leave the house;
• asking to "go home", even when they are at home;
• getting cross, tearful or suspicious;
• shadowing you and not wanting you out of sight;
• seeing or hearing things that are not there;
• trouble falling asleep, or waking and getting up in the night.

Doctors have noticed this evening pattern for more than 60 years^[2]. Even so, there is no single agreed definition, and experts still do not fully understand why it happens^[3]. So treat it as a pattern to watch, not a label. A GP, a memory clinic or the dementia team can help you work out what is going on.

Why late afternoon can be so hard

Nobody knows the full answer. Dementia can upset the body clock, the inner timer that tells us when to be awake and when to sleep^[4]. Add a long day, and the person may simply have run out of energy to cope.

Common triggers that families often spot:

• Tiredness. A busy morning or a missed rest can catch up by 4 pm.
• Fading light and shadows. Dim rooms make it harder to know where you are. Shadows and reflections can look like people.
• Hunger or thirst. A late or small lunch can leave someone low and irritable.
• Pain or discomfort. Sore joints, a full bladder, constipation or feeling too hot or cold. The person may not be able to say what hurts.
• Noise and bustle. The TV, children home from school, cooking, visitors and phones all at once.
• Change of staff or faces. In care homes, shift changes often fall in the afternoon.
• Too little to do. Long empty hours can turn into restlessness.

Pain deserves a special mention. In a trial in Norwegian nursing homes, a careful, step-by-step approach to finding and treating pain reduced agitation in people with moderate to severe dementia^[5]. You cannot see pain from the outside, but a doctor can check for it.

Keep a diary for two weeks

Before you change anything, watch. The NHS suggests keeping a diary for 1 to 2 weeks to find triggers^[4]. A notebook by the kettle is enough.

Each day, jot down:

• what time the restlessness started and how long it lasted;
• what happened just before (a visitor, a nap, a bath, a phone call);
• when they last ate and drank;
• how much daylight and activity they had;
• how they slept the night before.

After a week or two, patterns often appear. Maybe it is worse on days without a walk. Maybe it starts right after the evening news. The diary also gives the doctor real facts instead of "she's been bad lately".

Build a calm afternoon routine

A predictable day is one of the most useful tools you have. MedlinePlus advises a daily routine, calm activities near the end of the day and the same bedtime every night^[1].

In the morning and early afternoon

• Get outside or sit by a bright window. The NHS suggests plenty of activity and daylight to help the body clock^[4].
• Plan the busier jobs early: appointments, baths, shopping, visitors.
• Go for a walk, garden, or do a simple chore together.
• Keep any nap short and early, so it does not steal night-time sleep.

From about 3 pm

• Turn the lights on before it gets dark. Close the curtains as dusk comes, so windows do not turn into black mirrors.
• Lower the noise. Turn off the TV news. Play music they loved when they were young.
• Offer a snack and a drink. Keep evening caffeine and alcohol low, as the NHS advises^[4].
• Give their hands something to do: folding towels, sorting buttons, looking through a photo album.
• Keep the same order of events each evening: tea, wash, pyjamas, a song, bed.

At night

• Use a night light so they can see where they are if they wake. Keep the bedroom dark enough to sleep.
• Cover or move mirrors if reflections upset them. MedlinePlus also suggests avoiding bare bulbs and shadows^[1].
• Leave a clear, lit path to the toilet.

You will not get every evening right. Aim for "calmer most days", not perfect.

What to do in the moment

When the agitation starts, your own calm matters more than any words. People with dementia often pick up the feeling in the room before they follow the meaning.

Try this order:

1. Slow down. Lower your voice. Sit down, so you are at their eye level.
2. Check the basics. Are they hungry, thirsty, cold, in pain, or needing the toilet?
3. Name the feeling, not the facts. "You seem worried. I'm here." This often works better than "You are home, look around."
4. Answer the need behind the words. "I want to go home" may mean "I feel unsafe". Offer comfort and something familiar, like a cup of tea or a favourite blanket.
5. Change the scene. A short walk in the hallway, a different room, a song.
6. Step back if it is not working. If they are getting angry, give them space, as long as they are safe.

Things that usually make it worse: arguing, correcting, rushing, lots of questions, and holding them back. MedlinePlus advises against restraining a person with dementia and suggests calm distraction instead^[1]. If you or they are ever in danger, call the emergency number: 999 or 112 in the UK, 112 in Ireland, 911 in the US, 000 in Australia.

For ideas on gentle phrases, see our guide on what to say to someone with dementia.

When to call the doctor

Sundowning that builds slowly over months is something to raise at the next GP appointment. Bring your diary. A doctor can look for causes you cannot see at home, such as pain, poor sleep, an infection, low mood or a side effect of a medicine. Any change to medicines is the doctor's or pharmacist's decision.

Talk to the doctor or pharmacist before giving any sleep product bought over the counter. MedlinePlus warns that many sleep aids can make confusion worse^[1].

Get help urgently if:

• the confusion is suddenly much worse than usual, over hours or a day or two;
• it carries on through the morning, not only in the evening;
• they seem very drowsy, feverish or unwell;
• they have a fall, a new weakness, or slurred speech.

A sudden change can be a sign of delirium, a sudden state of confusion often caused by an illness such as a urine infection. The NHS says to go to A&E or call 999 if someone suddenly becomes confused^[6]. Our article on sudden confusion in elderly people explains the difference in more detail.

Look after the carer, too

Evenings are when carers are most tired as well. That is not a coincidence you can ignore. The NHS reminds carers that their needs matter as much as the person they care for, and suggests asking a GP for support if things feel hard^[4].

A few things that help:

• Ask a relative or friend to take one or two evenings a week.
• Prepare dinner earlier in the day, so the evening is quieter for you both.
• Have your own wind-down plan after they are asleep.
• Join a local carers' group or a dementia charity forum.

If you notice you are snapping, not sleeping or dreading every evening, read our guide to signs of caregiver burnout.

Some families add a calm voice to the late afternoon. James, an AI voice companion that works in the browser, can read a poem or a book aloud a part at a time, and he changes how he speaks once the family tells him about a dementia diagnosis. He is not a carer or a doctor, and he can alert the family member the person chose. You can read how James handles dementia.

James is an AI, not a doctor. For medicines and treatment ask your doctor or pharmacist.

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