Understanding Sundowning: Why Late-Day Confusion Happens and How to Manage It

If your loved one living with dementia becomes more agitated, confused, or restless in the late afternoon or evening, they may be experiencing sundowning. This common symptom of dementia can make the evening hours particularly challenging for both caregivers and those living with dementia. Understanding why sundowning happens and how to manage it can help create a more peaceful end to the day.

Why Does Sundowning Happen?

Sundowning is believed to be caused by a combination of biological, environmental, and emotional factors. Some of the most common triggers include:

Disrupted Body Clock: Dementia affects the brain’s ability to regulate the sleep-wake cycle, making it harder to distinguish between day and night.

Fatigue: As the day goes on, exhaustion can set in, leading to increased confusion and agitation.

Changes in Light Levels: Dim lighting and shadows can make the environment feel unfamiliar or even frightening.

Hunger or Thirst: Unmet physical needs can contribute to discomfort and distress.

Overstimulation: A busy or noisy day can lead to sensory overload, making it harder to stay calm in the evening.

Unmet Emotional Needs: Feelings of loneliness, fear, or frustration may intensify in the late afternoon or evening.

How to Manage Sundowning

While sundowning can’t always be prevented, there are strategies to reduce its intensity and help your loved one feel more at ease.

Stick to a Routine: A consistent daily schedule provides a sense of security. Try to keep meals, activities, and bedtime at the same times each day.

Maximize Daylight Exposure: Encourage your loved one to spend time in natural sunlight during the day, whether by sitting near a window, going for a short walk, or spending time outdoors. This helps regulate the body’s internal clock.

Reduce Stimulation in the Evening: As the day winds down, create a calm and quiet environment. Lower the lights, minimize background noise, and switch to relaxing activities like listening to soft music, looking at photo albums, or engaging in gentle conversation.

Offer Comfort and Reassurance: If confusion or distress sets in, avoid arguing or trying to reason with your loved one. Instead, use a soothing voice, gentle touch, and familiar objects to help them feel safe.

Manage Physical Needs: Ensure that your loved one has eaten a satisfying meal and is hydrated before evening. If necessary, offer a light snack before bedtime.

Limit Naps and Caffeine: Long or late-afternoon naps can disrupt nighttime sleep, which may make sundowning worse. Encourage brief naps earlier in the day and avoid caffeine after lunchtime.

Use Lighting to Reduce Shadows: As daylight fades, turn on soft, warm lights to keep the environment well-lit and reduce shadows that might cause confusion or fear.

Keep Evenings Predictable: Engage in soothing, familiar activities in the evening, like watching a favorite TV show, reading aloud from a beloved book, or following a calming bedtime routine.

When to Seek Help

If sundowning becomes severe and interferes with sleep or safety, speak with a doctor. Medication, environmental adjustments, or professional guidance may be needed to help manage the symptoms.

You’re Not Alone

Sundowning can be exhausting and emotionally draining for caregivers, too. It’s important to take breaks, ask for help, and seek support when needed. By making small adjustments and staying patient, you can help create a calmer and more comforting evening for your loved one.

If you need dementia caregiver support, please join my dementia support group or schedule your 30-minute consultation.