Sundowning: when confusion gets worse in the evening

Many families notice that a parent with dementia does fairly well in the morning and becomes restless, upset or confused as the day fades. That pattern has a name, sundowning. This note explains it and collects practical tips from the National Institute on Aging.

What sundowning is

Sundowning is restlessness, agitation, irritability or confusion that begins or gets worse as daylight fades, in the late afternoon or early evening.¹ It can last into the night and disrupt sleep for the person and the caregiver.¹

What may cause it

Changes in the brain from Alzheimer’s disease may upset the body’s internal clock. Being overtired, hunger or thirst, depression, pain and boredom can all make it worse.¹

During the day

Let in natural light during the day, or sit by a bright window, to help set the body clock.¹ Encourage physical activity every day.¹ Keep naps short and not too late in the day.¹ Don’t overschedule: being overtired can increase restlessness.¹

In the evening

Make the evening quiet and predictable: soothing music, reading, a walk, a call from a family member.¹ Use softer light in the evening.¹ Cut down noise, clutter and the number of people in the room.¹ Avoid caffeine late in the day, and avoid alcohol, which can worsen confusion.¹

In the moment

Stay calm. Listen, reassure, and gently redirect away from what’s upsetting.¹ A favorite snack, a familiar object or a simple task, like folding towels, can help.¹ Familiar TV shows are fine; the news usually isn’t.¹

When to talk to the doctor

If sundowning continues, ask for a medical exam to look for pain, a sleep problem, another illness or a medicine side effect.¹ If a medicine for sleep or calm is suggested, ask about side effects; some increase dizziness, falls and confusion, and doctors generally recommend them for short-term use only.¹

Help at home

A home health nurse can look for treatable causes like infection or pain and review medicines. If dementia has become advanced, ask whether hospice could help; our note on hospice for dementia explains when it may fit.