Sundowning is the late-afternoon and evening rise in confusion, restlessness, anxiety, or agitation that many people with Alzheimer’s and other dementias experience. It isn’t a disease of its own. It’s a pattern, and it usually responds best to routine and environment changes: daylight and activity early in the day, fewer demands after mid-afternoon, a well-lit home at dusk, and a calm, predictable evening. If behavior changes suddenly over a day or two, think infection, pain, or a medication problem first, and call the doctor.
I pulled this together from the National Institute on Aging’s guidance on agitation and sundowning and the Alzheimer’s Association page on sleep issues and sundowning, both checked October 10, 2026. I research senior health and caregiving topics for readers; I’m not a doctor or nurse.
What sundowning looks like
Families describe it in similar ways. Around 4 or 5 p.m., a parent who was fine at lunch starts pacing, asking to “go home” while sitting in their own living room, getting suspicious, or refusing help. Some people see things in the shadows. Others shadow a caregiver from room to room. It can last a few hours or run into the night and wreck everyone’s sleep.
Common signs:
- Restlessness, pacing, or rummaging
- More confusion about time and place
- Anxiety, irritability, crying, or yelling
- Wanting to leave, or trying to
- Suspicion or seeing things that aren’t there
- Trouble falling or staying asleep
Why it happens
Nobody knows the exact cause, but the Alzheimer’s Association lists several factors that pile up late in the day:
- Mental and physical tiredness after a full day
- A mixed-up body clock, so the person feels sleepy during the day and alert at night
- Low light and shadows, which can be misread and frightening
- Picking up on caregiver stress at the end of a long day
- New or confusing surroundings, such as a hospital, a move, or visitors
- Less need for sleep, which is common with age
NIA adds the usual triggers for agitation in general: pain, constipation, hunger or thirst, too much noise, too many people, being rushed, and medication side effects or interactions.
First, rule out what isn’t sundowning
Sundowning builds gradually and follows a daily rhythm. Delirium comes on fast, over hours to days, and the person may be much more drowsy or confused than usual at any time of day. In older adults it’s often triggered by a urinary tract infection, dehydration, a new medicine, constipation, poor sleep, or surgery. Delirium is a medical problem that needs prompt attention.
Call the doctor the same day if you notice:
- A sudden jump in confusion or a new level of agitation
- Fever, burning with urination, new incontinence, or a strong urine smell (see my guide to UTIs in seniors)
- Not eating or drinking, or very little urine
- New falls, or new hallucinations
- A medication was recently started, stopped, or changed
Call 911 and say the person has dementia if there’s danger to anyone’s safety.
A day plan that helps
Most of what works happens before the sun goes down. This is a combined version of the NIA and Alzheimer’s Association tips, arranged by time of day:
| Time of day | What to try |
|---|---|
| Morning | Get outside or sit by a bright window. Schedule bathing, appointments, and errands now, when people are usually most alert |
| Midday | Make lunch the biggest meal. Keep the person active, but don’t overbook the day |
| Mid-afternoon | No caffeine (coffee, tea, cola) or alcohol. Keep naps short and early |
| Late afternoon | Turn lights on before dusk and close curtains to cut shadows. Put on quiet music or a familiar activity |
| Evening | Light supper. Low noise, no busy TV news, few visitors. Same bedtime steps every night |
| Night | Night lights in the bedroom, hallway, and bathroom. Clear the path. Keep a simple log of what happened before each episode |
In the moment: what to say and do
When an episode starts, arguing almost never works. The approaches both organizations recommend:
- Stay calm and speak slowly. Keep your voice low. Take a breath (or count to 10) before you respond.
- Look for a need. Are they hungry, thirsty, cold, in pain, or needing the bathroom?
- Reassure rather than correct. “You’re safe. I’m right here” usually works better than explaining that this is home.
- Gently remind them of the time if it helps, but drop it if it upsets them.
- Redirect. A snack, a drink, folding towels together, a favorite song, old photos, or a short walk.
- Let them pace safely. The Alzheimer’s Association advises against physical restraint; supervision is better.
- Protect everyone. Lock up car keys, firearms, and sharp tools. If they become aggressive, step back to a safe distance until it passes.
Keep a trigger log
The Alzheimer’s Association suggests noting what happens before each episode. A notebook works. Write down the time, what happened in the hour before (a visit, a nap, a meal, a noisy TV, a bath), what they said, and what calmed it down. After a week or two, patterns usually show up, and they’re useful to bring to the doctor.
What about medications?
Talk with the doctor before trying any sleep aid or supplement. Several common over-the-counter sleep products contain antihistamines like diphenhydramine, which can make confusion worse in older adults (more in my article on medications linked to memory problems). Doctors sometimes adjust the timing of existing medicines, treat pain or depression, or address sleep problems such as sleep apnea. Antipsychotic drugs carry serious risks for people with dementia and are generally reserved for severe cases where other approaches haven’t worked.
What Medicare can help with
Original Medicare covers a cognitive assessment and care planning visit with your loved one’s doctor. That visit is a good place to bring the trigger log, review medications, and make a plan for behavior changes, safety, and caregiver support. Normal Part B cost sharing applies.
Look after yourself, too
Evenings are hardest on caregivers, who are tired too. Try to get a break earlier in the day, accept help in the late-afternoon window if family or a paid aide can cover it, and know the warning signs of caregiver burnout. The Alzheimer’s Association runs a free 24/7 Helpline at 800-272-3900, and the NIA ADEAR Center (800-438-4380) can point you to local resources. The National Family Caregiver Support Program may pay for respite care in your area.
Common questions
What time does sundowning usually start?
It usually begins in late afternoon or early evening as daylight fades and can continue into the night.
Is sundowning a sign that dementia is getting worse?
Not necessarily. It’s common in the middle and later stages, but it can come and go. A sudden change over days is more likely an infection, pain, or medication problem and should be checked.
How do you calm someone who is sundowning?
Stay calm, check for needs like hunger, pain, or the bathroom, reassure instead of arguing, reduce noise, turn on lights, and redirect to a familiar, soothing activity.
Can a UTI cause sundowning?
A urinary tract infection can cause delirium, a sudden worsening of confusion that can look like severe sundowning. Call the doctor if confusion spikes suddenly.
Does melatonin help sundowning?
Research results are mixed. Ask the doctor before starting melatonin or any sleep aid, especially products with antihistamines.
Written by Khasim Basha Shaik. I research senior health and caregiving topics and summarize official guidance for readers. I’m not a doctor, nurse, or licensed clinician. This article summarizes National Institute on Aging and Alzheimer’s Association information and is not medical advice. Last reviewed October 10, 2026.
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