Sundowning
Sundowning: What It Is, What It Looks Like, and How to Get Through the Night
Published on Florence for Caregivers | For family caregivers and loved ones
It usually starts around late afternoon or early evening. Your loved one, who may have been perfectly calm and cooperative all day, begins to change. The confusion deepens. The agitation rises. A person you know to be gentle starts pacing, arguing, or trying to leave the house. Someone who hasn't been afraid of anything in years is suddenly terrified of something only they can see.
This is sundowning. And if you have never encountered it before, it can be one of the most frightening and bewildering things a caregiver faces.
What Is Sundowning?
Sundowning, sometimes called sundown syndrome, is a pattern of increased confusion, agitation, and behavioral changes that occurs in the late afternoon and evening in people with dementia. It is not a separate disease. It is a symptom, and a common one.
Nobody fully understands why it happens. The leading theories involve disruption to the brain's internal clock, fatigue accumulating over the course of the day, changes in light, and shifts in the brain chemistry of someone with dementia as the day progresses. What we know practically is that it is real, it is exhausting, and it follows its own timeline regardless of what you do.
The behaviors associated with sundowning can include:
Extreme confusion, not recognizing familiar people or places
Agitation and restlessness that seems to come from nowhere
Sudden mood swings, calm one moment, distressed the next
Hallucinations, seeing, hearing, or believing things that aren't there
Attempts to wander or leave, often with a specific destination in mind that makes sense only to them
Repetitive behaviors or questions
Suspicion or accusation, convinced something has been stolen, or that someone means them harm
It can look, in a word, like a Jekyll and Hyde transformation. The person you were caring for an hour ago seems to have been replaced by someone else entirely.
The One Thing That Does Not Work
Before I tell you what helps, I need to tell you what doesn't, because most people's first instinct is exactly wrong.
Do not try to re-orient them to reality.
This feels counterintuitive. When your mother insists there is a robber outside the window, the natural response is to say "Mom, there is no robber. Look, the street is empty. You're safe." When your father says he needs to go home, from the house he has lived in for forty years, the natural response is to gently remind him that he is home.
It doesn't work. It cannot work, because the part of the brain that processes and accepts that kind of correction is not functioning the way it used to. What you get instead is escalation. They become more agitated, more distressed, more insistent, because from where they are standing, you are the one who is wrong, and you are not listening to them.
Arguing with someone in the grip of sundowning is like arguing with a dream. The dream does not respond to logic.
What Actually Helps
Accept that you cannot stop it, you can only navigate it.
This is the hardest truth about sundowning, and the most important one. You will not stop it from happening. Fighting it, correcting it, or trying to reason your way through it will only make things worse. The goal is not to eliminate the behavior, it is to keep your loved one safe and as comfortable as possible until it passes.
If your loved one wants to pace, let them pace. Clear the path of anything they could trip on, throw rugs are especially dangerous. Give them space. Walk with them if needed. Pacing can actually be self-soothing for someone in distress.
Enter their reality.
This is the approach I used with my own clients, and it is the one that works. Instead of correcting what they are experiencing, you acknowledge it and resolve it within the world they are currently inhabiting.
When one of my clients was convinced there was a robber outside her window, I didn't tell her there was no robber. I told her I had already called the biggest policeman I knew, and he had come over and taken the robber straight to jail. She was safe now. She relaxed. We moved on.
When another client was determined to leave for her daughter's house, I didn't block the door or argue. I said her daughter Kelly had called and said hello, and that she would see her tomorrow. She was satisfied. The urgency dissolved. We moved on.
If your loved one wants to call or visit someone who has passed away, don't tell them that person is gone. That grief will be fresh and devastating every single time. Instead, tell them that person is away for the evening, or on vacation, or will call tomorrow. It is not deception. It is mercy.
If they are determined to go somewhere, pretend to call ahead on your phone and find out the place is closed for the night, they can try again tomorrow. Meet them where they are.
This approach is sometimes called validation therapy or compassionate fibbing, and it has solid support in dementia care. Their distress is real. Their fear is real. Addressing it in the only way that can reach them is not dishonesty, it is compassion.
Agree, then redirect.
Never argue. Never correct. Agree with whatever they are experiencing, and then gently shift the focus to something else entirely. Music they have always loved. A simple activity with their hands. Sorting socks or folding towels works remarkably well for some people, giving them something purposeful to do that can ease restlessness and even bring on drowsiness. A favorite television program. A snack. A memory from their past that brings them happiness.
Having a few dedicated distraction items on hand can make all the difference. Large print playing cards are easy to handle and familiar to most seniors. The QUOKKA Memory Card Game was designed specifically for dementia patients with visual clues and two difficulty levels. It can engage without frustrating. And a large print activity book with simple puzzles offers quiet, calming engagement that is particularly well suited to the afternoon and evening hours when sundowning typically occurs. Keep these within easy reach before sundowning begins, not scrambled for in the middle of it.
The key is to make the redirect feel natural. Don't announce it, just do it. Start talking about something else. Put the music on. Hand them the basket of socks.
Create a calming environment.
Sundowning is often made worse by overstimulation. In the late afternoon, begin lowering lights gradually, reducing noise, and decreasing activity. Soft music, gentle outdoor sounds, familiar scents, and warm lighting can all help create an environment that soothes rather than agitates.
Some caregivers find that a car ride, even just around the block, can help break the cycle of agitation. Fresh air, movement, and a change of scenery can reset the mood in ways that nothing indoors can.
Give them your presence and your love.
Sometimes the most powerful thing you can offer is simply to be there. A hand to hold. A calm voice. The reassurance that everything is going to be okay. Your loved one may not be able to process complex information during sundowning, but they can feel whether the person beside them is calm and loving or frightened and frustrated.
Your emotional state is contagious. Stay calm, not because you feel calm, but because calmness is one of the most effective tools you have.
Know their pattern.
Sundowning is often predictable. It tends to happen at roughly the same time each day. Once you recognize when it typically starts, you can prepare. Finishing tasks that require cooperation before that window, making sure they have eaten, reducing stimulation, and having your strategies ready before the behavior begins rather than scrambling to respond once it has.
Sometimes You Just Ride It Out
I want to be honest with you about something, because the caregiving books don't always say it plainly enough.
Sometimes nothing works. Sometimes the agitation peaks and there is nothing to do but stay present, keep them safe, and wait for it to pass.
That is not a failure. That is the reality of this disease.
There will be nights when your loved one paces for hours, when every attempt at distraction is rejected, when the hallucinations cycle and cycle and nothing resolves them. On those nights, your job is not to fix it. Your job is to stay calm, keep them safe, and accept that this is your reality until they eventually wind down and go back to bed.
Staying calm is harder than it sounds, especially at 2am after weeks of broken sleep. But your emotional state directly affects theirs. When you are calm, it is easier for them to become calm. When you are frightened or frustrated, it amplifies their distress.
This is one of the reasons caregiver relief and rest are not optional. You cannot stay calm night after night on no sleep. If you are the primary caregiver for someone who sundowns regularly, you need a plan for getting adequate rest, whether that means another caregiver taking night shifts, a family member rotating in, or a conversation with the doctor about whether there are medical options that might help.
When to Talk to the Doctor
Sundowning is common in dementia, but it is not something you simply have to endure without any support. Talk to your loved one's physician if:
The sundowning is severe or dangerous, if your loved one is at risk of hurting themselves or others
It is significantly worsening over time
You are not getting adequate rest and it is affecting your ability to provide safe care
You want to know whether there are medical interventions that might help
Always follow your physician's orders and involve them in any decisions about managing sundowning behaviors.
A Final Word
Sundowning is one of the hardest parts of dementia caregiving. It is unpredictable, exhausting, and emotionally draining in a way that is difficult to explain to someone who hasn't lived through it.
But it is manageable. Not perfectly, not every night, but manageable. Enter their reality. Redirect gently. Keep them safe. Stay calm. And on the nights when nothing works, accept that riding it out is sometimes the only option available to you.
You are not failing when that happens. You are caregiving.
Florence for Caregivers provides general information for family members and laypeople caring for aging loved ones at home. This content is not a substitute for professional medical or clinical advice. Always follow your physician's orders and consult qualified healthcare professionals for medical decisions.
This site contains affiliate links. If you purchase a product through our links, we may earn a small commission at no additional cost to you. We only recommend products we genuinely believe are helpful.