If you care for someone with dementia, you may notice their mood, behaviour, or awareness shift as evening approaches.
This pattern, commonly known as sundowning or sundowning syndrome, can bring increased confusion, agitation, anxiety, or restlessness in the late afternoon and early evening.
Sundowning can be one of the most challenging aspects of dementia care. Watching a loved one become distressed or unsettled at the end of the day can feel overwhelming, especially when you’re unsure what’s causing it or how best to respond. Many carers describe feeling helpless, exhausted, and unsure where to turn for support.
The good news is that there are practical, evidence-informed ways to ease these symptoms and create a calmer, more reassuring environment. With the right strategies, routines, and understanding, it’s possible to reduce distress for both you and the person you care for.
In this guide, you’ll learn what causes sundowning, how to recognise the signs, and the steps you can take to make evenings more manageable and less stressful for everyone involved.
What is sundowning?
To provide trusted, expert guidance, we spoke with Dementia UK Admiral Nurse Mutsai Hove Bird about how specialist dementia nurses approach sundowning.
Sundowning is a term referring to changes in behaviour of a person with dementia in the late afternoon and evening, normally around dusk. People with sundowning dementia experience a heightened level of anxiety, distress or agitation at this time. It can occur in people with different types of dementia, including Alzheimer’s.
Admiral Nurse, Mutsai Hove Bird adds: “Other symptoms might include shouting or arguing, pacing, or becoming confused about who people are and have a compelling sense that they are in the wrong place. The person with dementia might say they need to go home, even if they are home.”
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What causes sundowning?
Despite its name, sundowning is not caused predominantly by the change in light levels – though that may be a factor. It is likely that sundowning occurs due to a disruption in the circadian rhythm of people with dementia, i.e. their body clocks.
This can cause people with dementia to have disruptions in their sleep patterns. As the day wears on, the person with dementia becomes more tired and therefore is more likely to feel confused and agitated.
According to Psychology Today, recent opinion suggests the body relies on consistent environmental cues, such as sunlight and temperature, to regulate physiological processes. Seasonal changes can disrupt these cues, leading to hormonal imbalances that affect mood, sleep, and overall well-being.
Two key hormones – melatonin and serotonin – are crucial for regulating sleep patterns and mood stability. Melatonin, which controls the sleep-wake cycle, is influenced by light exposure. Shorter daylight hours in winter lead to increased melatonin production in the evening, which can contribute to grogginess and disrupted sleep. Conversely, serotonin, known as the “feel-good” hormone, is produced in response to sunlight. Reduced sunlight in colder months can lower serotonin levels
In addition to hormonal changes, seasonal allergies and fluctuating air quality can also impact cognitive function. High pollen counts in spring and fall can trigger inflammation, leading to discomfort, poor sleep, and increased irritability. Indoor air quality in winter may also worsen due to dry, heated air, which can cause dehydration: a factor linked to confusion and cognitive decline.
Many people with dementia struggle to sleep. Read our top tips for helping someone with dementia to sleep better.
Other factors that may lead to sundowning
There are other factors that can contribute to increased agitation in the late afternoon/early evening for people with dementia. The causes may be different for different people, so it may be worth trying to address different factors one at a time and seeing what makes a difference.
Reduced lighting and increased shadows
If a person is feeling confused due to their dementia, reduced lighting and the inability to see things, can compound this. Darkness can increase uncertainty about where they are, which can contribute to people with sundowning syndrome thinking that they are "in the wrong place".
Loss of routine at a previously busy time of day
A person may be used to a previously busy routine in the afternoon. For example work or a social activity. The transition can be confusing as their expected routine fails to materialise which can cause confusion and agitation.
Carers can become exhausted
Caring for someone with dementia is incredibly stressful and they might be responding to your tiredness or anxiety. Sadly, this can increase their confusion and agitation.
Being hungry and thirsty
Being hungry and thirsty can cause confusion. People with dementia can forget, or refuse, to eat and drink. This can take its toll over the course of the day, and lead them to feeling uncomfortable without knowing why. You may want to read our tips on getting someone with dementia to eat more.
Prescribed medication wearing off
If your relative takes prescribed medication at a fixed point in the day, it may wear off in the afternoon or evening.
It is important to remember that a person with dementia being distressed is not necessarily sundowning behaviour. They may be trying to communicate a specific need to you, such as pain or constipation.
Tips for Managing sundowning
There is not a simple ‘cure’ for sundowning behaviour. The best thing that you can do is find ways of managing your relative’s sundowning when it happens and take steps to prevent the agitation that they feel in the afternoon and evening. If your relative is feeling very restless or agitated, there are simple things that you can do to comfort them.
Skills for Care has developed a brand-new set of dementia care resources (May 2026) including a downloadable guide to distressed behaviour.
Approach them calmly
Approach the person in a calm reassuring manner and avoid arguing.
Try to identify the cause of distress
Try to talk slowly in a reassuring way and listen carefully to their response to see if you can deal with source of distress which may include hunger, thirst or needing to go to the toilet.
Use distraction techniques
If there is no distinct cause of their distress then try to focus their attention on a simple activity. This could be going into a different room, making a drink, having a snack, turning some music on, or going out for a walk.
Consider the physical environment
Try to maintain a calm physical environment. Minimise noise and lights.
Tips for preventing sundowning
There are a number of steps that you can take to prevent sundowning. Because there are many factors that contribute to sundowning, not all of these tips will work for everyone. It is best to keep a record of what does and does not work for your relative.
Maintain a routine
Routine is very important for managing and preventing sundowning. Try to keep mealtimes, sleeping times and waking up times consistent. Having a consistent daily routine also reduces worries about being "in the wrong place", which is common for sundowners.
Plan relaxing afternoon activities
A good way of managing sundowning is to plan relaxing afternoon activities. This could be as simple as watching a certain TV show everyday, having a phone call at a fixed time, or doing a puzzle.
Encourage trips outside while it is light
Spending time outdoors in the natural light is a good idea for people prone to sundowning.
If a person's body clock is distorted, they may expect it to be light when it is not. Making sure a person has been in the natural daylight when they can means they are less likely to feel confused about the time of day, or that they have not been outdoors for a while.
Make sure that they have been eating and drinking
Maintaining a generally good standard of care is important. Making sure that the person you're caring for has been eating and drinking, and using the toilet regularly, is also likely to improve mood and health for people with dementia.
Improve lighting in the home
Close curtains and turning on the lights as light changes from day to night to help reduce disorientation between day and night-time.
Avoid stimulants
Stimulants such as caffeine and alcohol can lead to people feeling more distressed and agitated. Caffeine-free and alcohol-free drink alternatives are available, and they may not notice the switch.
Track what helps and what doesn't
Track the behaviour of your relative and try to work out if specific things trigger their sundowning behaviour. Also keep notes of what seems to help them, or keep them relaxed. Take a look at our page on useful apps for keeping track of care at home.
Look after yourself
We know that people with dementia may take stress cues from their carers. Make sure that you are looking after yourself so that you can feel less stressed when with your relative. You may want to read our guide to care for the carer.
Some people find that avoiding naps in the day is a good idea, in order to keep the sundowner close to the body’s natural circadian rhythm. Other people find that a short afternoon nap helps to alleviate agitated behaviour due to tiredness in the evening. Whether or not napping is effective will depend on how well your relative is able to sleep through the night.
Wandering can also be an issue, as both a potential cause and effect of sundowning. While it can be difficult to minimise wandering, you can limit the stress and time involved in a wandering episode by the person wearing a dementia tracker – a device that enables carers to know when the wearer is leaving an area at an odd time and locate them easily.
Look at our guide to dementia products, which includes products for people with dementia to sleep better.
Frequently Asked Questions about Sundowning
Does sundowning happen to all people with dementia?
Sundowning is a common issue for many people with dementia. It tends to occur in mid-to-late stages of dementia where it affects up to two in three people (66%) of people who have dementia.
Is sundowning more common with certain types of dementia?
Sundowning can occur with all types of dementia. It is not known if it is more prevalent in certain types.
How long does sundowning last?
Sundowning does not last a fixed amount of time. It can pass in a matter of minutes or last all afternoon and evening. It will vary person-to-person and day-to-day.
Should I seek medical help to manage sundowning?
The Admiral Nurse that we spoke to says: "Always seek medical advice if you are concerned about changes in behaviour in someone with dementia. While the behaviour may be attributed to sundowning, it is important that other causes of distress / discomfort such as pain or a urinary tract infection are managed. In some cases where lifestyle changes fail to prevent or reduce impact of anxiety and agitation on the person with dementia, medication may be prescribed."
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This article has been written using information from trusted organisations. Their guidance helps ensure the information here is accurate and reflects current UK law and best practice.
- Psychology Today, How Seasonal Changes Impact Dementia Sundowning Symptoms, March 2025.
- Journal of Clinical Medicine, Sundowning Syndrome in Dementia: Mechanisms, Diagnosis, and Treatment, February 2025.
- Skills for Care, Distressed Behaviour.
- National Library of Medicine, Behavioral and Psychological Symptoms in Dementia, February, 2024.
- NHS, Coping with dementia behaviour changes, January 2024.
- NHS, What are the treatments for dementia, July 2023.
- Many people with dementia struggle to sleep. Read our top tips for helping someone with dementia to sleep better.
- Delirium or dementia? Delirium is a mental condition that is often mistaken for dementia. In this guide you can find out more about the distinctions between the two, as well as the signs of delirium and its treatment.
- Find out how an Admiral Nurse working with Dementia UK helped a family troubled by mum’s sundowning.
- Advice from the Alzheimer’s Association on getting help and support as a carer for someone living with dementia.
