Quick Description: Sundowning—a pattern of increased confusion and behavioral changes that tends to emerge in the late afternoon and evening hours—is a common experience among those living with Alzheimer’s disease and other forms of dementia. This guide explains what sundowning looks like, explores the contributing factors, and offers practical, compassionate strategies caregivers can draw on to navigate these challenging moments.
Disclaimer: At The Bristal, we believe that transparency is important and that language matters. We use person-first language whenever possible to honor the dignity of people living with dementia. To reach those actively searching for information, we occasionally include commonly searched terminology that is less person-driven. This choice supports accessibility and discoverability, but does not reflect our philosophy of care.
If you’ve noticed that the person in your care seems more confused, restless, or agitated as the afternoon turns to evening, you’re not alone, and what you’re observing may have a name.
Sundowning, or sundowner syndrome, refers to a pattern of behavioral and cognitive changes that typically emerge in the late afternoon and persist into the evening and nighttime hours. It is a common experience among those living with Alzheimer’s and other forms of dementia, and understanding it can make a meaningful difference for both the person experiencing it and the caregivers supporting them.
The Bristal is here to help you better understand sundowning and provide the information and support you need.
What Is Sundowning?
The Alzheimer’s Association defines sundowning as increased confusion and disorientation that begins at dusk and may continue through the night. Neuropsychologists who specialize in dementia care note that it is a well-recognized phenomenon in those living with cognitive changes, not a separate condition, but a pattern of symptom expression that follows a predictable daily rhythm.
At The Bristal, team members in the Reflections memory care neighborhood are trained to recognize and respond to sundowning as part of the broader cognitive support landscape. Understanding what to look for is a meaningful first step for any caregiver navigating this experience at home.
What to Watch For With Sundowning
Sundowning can express itself in a range of behaviors. Common symptoms include:
- Increased confusion or disorientation
- Restlessness or pacing
- Anxiety or agitation
- Crying or calling out
- Paranoia or suspicion
- Shadowing (following a caregiver from room to room)
- Wandering
- Hallucinations
- Resistance to directions or redirection
- Difficulty sleeping
Because many of these behaviors also characterize dementia more generally, the most reliable way to distinguish sundowning is timing. If the same behaviors appear consistently in the late afternoon or evening, even if the behaviors vary in intensity, this can be a meaningful signal.
Tracking occurrences in a simple journal, noting the time, duration, and your observations, can be helpful both for identifying sundowning and for informing conversations with a physician or care team.
It’s important to remember that no two experiences with sundowning are exactly alike. Symptoms can vary in both intensity and presentation, so what one person experiences may be very different from another.
What Causes Sundowning?
The precise causes of sundowning are not fully understood, and research continues. However, several contributing factors are widely recognized:
- Fatigue: By late afternoon, both the physical and cognitive demands of the day may have accumulated, lowering the threshold for confusion and agitation.
- Disrupted Sleep Patterns: Many people living with dementia experience changes in their sleep-wake cycles, which can intensify behavioral symptoms as evening approaches.
- Changes in Light: Reduced natural light, particularly in winter, may affect internal biological rhythms and contribute to disorientation.
- Hormonal Shifts: Changes in melatonin levels and other hormonal rhythms may influence symptom timing.
- Sensory or Environmental Factors: Increased noise or activity in the late afternoon, shadows created by dimming light, or changes in household routine may all serve as triggers.
- Unmet Needs: Sometimes, sundowning may be a person’s way of expressing a need they cannot verbalize—such as hunger, thirst, pain, or the need to use the restroom. Addressing basic comfort needs proactively in the late afternoon may reduce the frequency or intensity of symptoms.
- Memory of Past Routines: For many older adults, late afternoon and early evening were once a busy, emotionally charged time—children returning from school, a spouse coming home, dinner being prepared. The brain may retain an echo of that emotional rhythm even as other memories fade, contributing to restlessness as evening approaches.
Practical Strategies for Managing Sundowning
Although there is no one-size-fits-all solution, caregivers have identified a variety of strategies that may help lessen the frequency and intensity of sundowning episodes.
Create Consistency and Predictability: A steady daily routine, such as regular mealtimes, consistent wake and sleep times, and structured afternoon activity, can reduce the disorientation that often precedes sundowning. The brain responds to familiar rhythms; building them intentionally may help.
Plan Engaging Activities for the Late Afternoon: Because sundowning often peaks between 3:00 and 6:00 p.m., this window is a good time to schedule a walk, a gentle exercise session, or a familiar, calming activity that provides positive engagement without overstimulation.
Manage the Environment as Light Changes: As natural light fades, increasing indoor lighting can reduce the shadows and visual ambiguity that may trigger confusion. Use lighting timers to ensure this is an automatic, and not manual, process. Closing curtains before dusk can also help minimize the visual cue of darkening skies.
Limit Stimulation in the Late Day: Large gatherings, loud television, or busy household activity in the late afternoon may contribute to agitation. A quieter, more predictable environment during this window may support greater calmness.
Address Basic Comfort Proactively: Offering a light snack, a glass of water, and a bathroom visit in the early afternoon may reduce the likelihood of unmet needs escalating into behavioral distress later.
Redirect Gently and Calmly: When sundowning behaviors do emerge, a calm, reassuring response—redirecting to a favorite activity, a piece of familiar music, or a comforting routine—is often more effective than confrontation or correction. Meeting the person where they are emotionally, rather than attempting to reorient them to reality, may reduce the intensity of the episode.
Allow Safe Behaviors: Not every repetitive or unusual behavior requires intervention. If a behavior is not causing harm or distress, it may not need to be redirected at all. Activities such as pacing within a safe area, folding towels repeatedly, or other repetitive actions can serve a self-soothing purpose and may provide comfort, familiarity, or a sense of control. Rather than trying to stop the behavior, consider instead whether it may be meeting an emotional need and whether safety can be supported while it continues.
Speak With a Physician: Sundowning can sometimes be exacerbated by medications, pain, or underlying medical factors. A thorough review with a physician may help identify and address contributing causes. Some individuals may benefit from melatonin or other supportive interventions, always under medical guidance.
How Memory Care Communities Approach Sundowning
In a dedicated memory care setting, sundowning is understood as part of the daily experience of dementia—not a crisis to be managed, but a pattern to be supported with skill and compassion.
At The Bristal, Reflections team members are trained in the latest approaches to dementia care, including recognizing and responding to sundowning. The physical environment, thoughtfully designed with consistent lighting, calm spaces, and secure outdoor access, supports orientation and reduces common triggers. Programming is structured throughout the day to provide positive engagement at the right moments, with quieter, grounding activity built into the late afternoon for those who benefit from it.
If you are navigating sundowning at home and finding the evenings increasingly difficult, it may be worthwhile to explore what a dedicated memory care community could offer for both the person in your care and your own well-being.
A Note for Caregivers
Caring for someone experiencing sundowning can be genuinely exhausting and emotionally demanding. The late-afternoon and evening hours that were once simply the end of the day can become the most challenging stretch of it. Acknowledging that difficulty matters.
Connecting with a caregiver support group, like those offered at the Our Place Memory Cafe at a handful of select locations, can provide a space to share experiences, ask questions, and find genuine solidarity with others navigating similar terrain. You don’t have to carry this alone.
If you have questions about sundowning or would like to learn more about the Reflections memory care neighborhood at The Bristal, we welcome you to reach out.
This article was originally published in November 2022, and was revised in June 2026.
FAQs
What are the most common sundowning symptoms?
The most commonly observed symptoms include increased confusion or disorientation, restlessness, anxiety, agitation, pacing, wandering, and difficulty sleeping, all of which tend to emerge in the late afternoon or early evening. Shadowing (following a caregiver closely), paranoia, and hallucinations may also occur. The specific symptoms and their intensity vary from person to person.
What causes sundowning in people with dementia?
Several factors may contribute, including fatigue, disrupted sleep-wake cycles, reduced natural light, hormonal changes, environmental overstimulation, and unmet physical needs such as hunger, thirst, or discomfort. Previously learned, late-afternoon routines may also play a role. Exact causes are not fully understood, and a physician can help identify any contributing medical factors.
How do I know if my family member is experiencing sundowning or just having a difficult day?
The key indicator is consistency of timing. If behavioral changes occur reliably in the late afternoon and evening, rather than randomly throughout the day, that pattern is characteristic of sundowning. Tracking the timing and nature of behaviors over a week or two can help clarify the picture and inform a conversation with a healthcare provider.
What can I do to reduce sundowning episodes?
A consistent daily routine, gentle afternoon activity, proactive attention to comfort needs, and a calm, well-lit environment in the late afternoon can all help reduce the frequency and intensity of sundowning. A physician should be consulted to rule out medical contributors and discuss any supportive interventions that may be appropriate.
Does memory care help with sundowning?
Yes, in meaningful ways. A dedicated memory care community structures the day, including the late-afternoon hours, with sundowning in mind. Trained team members, thoughtful environmental design, and appropriate activity programming can all reduce the impact of sundowning and support both residents and families more effectively than managing at home alone.
