Dementia affects almost half a million Australians, but it’s projected to increase by 88% over the next 30 years.  While most of us understand that dementia impacts the way the brain processes information, it’s important that we continue getting more familiar with the disease as a whole.

Dementia can lead to changes in memory, thinking, and behaviour over time. People with dementia may act in ways that are confusing or unexpected, for both the individual with dementia and their loved ones.

As dementia progresses, changes in behaviour can become more noticeable. One common but often misunderstood example of this is sundowning. Sundowning refers to a pattern of increased confusion, restlessness, or agitation that tends to take shape in the late afternoon or evening.

Sundowning can be upsetting to witness, especially because it’s not controllable. If you want to support a loved one with sundowning, it begins with a good understanding of the condition. Developing patience and the proper strategies can make a world of difference for both the person living with dementia and those around them.

What is sundowning in dementia?

Sundowning is a term used to describe a pattern where a person living with dementia becomes more confused, anxious, restless, or upset during the late afternoon, evening, or night. These changes in behaviour can vary in intensity and may come on gradually as the day goes on.

Sundowning is not a type of dementia. It is an umbrella experience of a range of symptoms that some people with dementia exhibit. Not everyone with dementia encounters sundowning, but when it does happen, understanding the signs can help families and caregivers respond with confidence and compassion.
A text graphic with an explanation of sundowning in dementia.

When does sundowning typically happen?

Sundowning often begins in the late afternoon or early evening and can continue into the night. However, the exact timing can vary from person to person.

Some people may show signs earlier or later depending on their daily routine, overall health, or environment. It’s helpful to keep track of patterns so you can notice when symptoms tend to appear.

What does sundowning in dementia look like?

Sundowning can show up in different ways, and the signs can change from one day to the next. Some common behaviours include:

  • Restlessness – pacing back and forth or fidgeting.
  • Confusion – not knowing what time it is, where they are, or who the people around them are.
  • Yelling or crying – often without a clear reason why.
  • Paranoia – believing someone is stealing from them, hiding things, or trying to hurt them.
  • Mood changes – becoming suddenly angry, anxious, tearful, or withdrawn.
  • Refusing care – not wanting to bathe, eat, or follow a routine.
  • Shadowing – following a caregiver closely or becoming distressed if they leave the room.
  • Hallucinations – seeing or hearing things that aren’t there.
  • Sleep problems – trouble falling asleep, waking up often during the night, or confusing night and day.

As an example, someone with dementia who is usually calm during the day may become restless in the evening. They may start walking around the house or asking the same questions repeatedly. These behaviours often stem from old routines and can indicate confusion or a need for reassurance as the day ends.

Why does sundowning happen?

The exact cause of sundowning is not fully understood, but several factors may contribute to the condition:
An illustration of an older person with puzzle pieces floating around her. Confusion is a symptom of sundowning in dementia.

Disruption in the body’s internal clock
Dementia can affect the brain’s ability to manage sleep and wake cycles. This can lead to poor or irregular sleep, which may in turn contribute to sundowning. People who experience sundowning might also feel too restless or unsettled to fall asleep easily.

Fatigue
As the day goes on, tiredness can make confusion worse.

Overstimulation
Too much noise, activity, or light during the day can lead to stress in the evening.

Low lighting and shadows
As natural light fades, shadows can appear more confusing or frightening.

Hormonal changes
Dementia may affect hormone levels that influence mood and behaviour.

Unmet needs
Hunger, thirst, needing to use the toilet, or being in pain can all trigger distress if the person is unable to express it clearly.

Who is most affected by sundowning?

Sundowning is more common in people with moderate to severe dementia, although it can happen at any of the seven stages of dementia.

Some factors that may increase the risk include being in an unfamiliar environment (like a hospital or new care home), other health conditions, side effects from medications, and poor lighting or high noise levels in the home.
A photo of a young person's hand on an older person's shoulder. Gentle reassurance can be an effective way to manage sundowning in dementia.

How to Manage and Reduce Sundowning Symptoms

While sundowning can be challenging, there are ways to reduce its impact.

Environmental Strategies

  • Create a calm evening routine: Keep things predictable to help reduce confusion.
  • Improve lighting: Turn on lights before it gets dark to reduce shadows and help the person feel safer.
  • Lower noise and stimulation: Turn off the TV, avoid loud conversations, and try to keep the environment peaceful.

Health and Lifestyle Tips

  • Encourage regular activity: Gentle exercise and time in natural light during the day can help with sleep and mood.
  • Limit caffeine, sugar, and big meals in the afternoon and evening, as these can make restlessness worse.
  • Check for health issues: Pain, constipation, infections, or other health conditions can increase agitation.

Emotional and Communication Support

  • Be gentle: Speak in a soothing voice and use calm body language.
  • Try not to argue: It’s more helpful to comfort and redirect than to challenge the person’s beliefs.
  • Use comforting items: Soft music, a favourite blanket, or family photos can help reduce anxiety.
  • Experiment with interventions: Meditation and reminiscence therapy, for instance, are both useful practices in dementia care.

When to Seek Help for Sundowning in Dementia

While sundowning is generally manageable at home, it’s important to seek help if:

  • The person becomes aggressive or unsafe, putting themselves or others at risk.
  • You’re worried about their sleep or health.
  • You feel overwhelmed or stressed as a caregiver.

In some cases, doctors may recommend medication, but this is typically only considered when it can be administered under professional guidance and when other options haven’t worked.
A text graphic explains when to seek help for sundowning in dementia.

Support groups and dementia helplines can also offer advice and comfort. You can contact the National Dementia Helpline on 1800 100 500 (available 24/7) or visit Dementia Australia for information, support services, and communities.

Additional Dementia Support

At the end of the day (quite literally), sundowning is a common symptom of dementia that can be confusing and stressful. But it’s important to know you are not alone. With patience, routine, and the right support strategies, many families find ways to manage it.

If you are caring for someone with dementia, remember to take care of yourself, too. Reach out for help when you need it, and know that your efforts make a real difference in your loved one’s quality of life. You can also contact The CareSide to learn more about dementia home care, including personal care and nursing care services.