How to Reduce Sundowning in Dementia: 12 Gentle Tips for Calmer Evenings

The mornings are fine. Your loved one is chatty, maybe even cheerful. Then the light starts to fade, and everything changes. They pace. They ask the same question over and over. They want to go home, or they become angry and suspicious.

If this sounds familiar, you may be seeing sundowning. It is common, it is not your fault, and while you can't always stop it completely, there is a lot you can do to make evenings calmer. Here's what causes sundowning and 12 practical tips to reduce it.

What is sundowning?

Sundowning is a pattern where a person with dementia becomes more confused, anxious, restless or agitated in the late afternoon, evening or night. The Alzheimer's Association describes symptoms such as:

• Confusion and anxiety
• Agitation, pacing or wandering
• Yelling, or being demanding or suspicious
• Seeing or hearing things that aren't there
• Trouble sleeping

It can happen at any stage, but many families notice it more in the middle stages.

What causes sundowning?

Experts don't know the exact cause. Things that may play a part include:

• Tiredness at the end of a long day
• Low light and shadows, which can be confusing or frightening
• A disturbed body clock, which dementia can affect
• Unmet needs such as hunger, thirst, pain, or needing the toilet
• Too much noise or activity in the evening
• Boredom after a quiet afternoon
• Picking up on your stress, because people with dementia often sense the mood around them

Knowing the likely triggers helps you choose which tips to try first.

12 ways to reduce sundowning

Daytime habits

1. Get daylight in the morning. Open the curtains early and, if you can, go outside for a short walk. Natural light helps set the body clock.

2. Keep a steady daily routine. Wake, meals, activities and bedtime at roughly the same times each day. Predictable days feel safer.

3. Plan busy things for the morning. Doctor visits, bathing, shopping and visitors are usually easier earlier in the day.

4. Keep naps short. A long afternoon sleep can make nights restless. If a nap is needed, keep it short and earlier in the day.

5. Move every day. A walk, gentle stretches or dancing to old songs helps use up energy and can improve sleep.

What they eat and drink

6. Cut caffeine and alcohol later in the day. Tea, coffee, cola and alcohol can all add to restlessness. Switch to caffeine-free drinks after lunch.

7. Make lunch the bigger meal. A lighter dinner can help settle the evening. Offer a small snack and drink before the usual sundowning hour, because hunger and thirst are common triggers.

The evening environment

8. Turn the lights on before it gets dark. Close curtains at dusk and keep rooms well lit to reduce shadows that can look like people or strange shapes.

9. Lower the noise. Turn off loud TV news, limit visitors in the evening, and play calm, familiar music instead.

10. Create a wind-down ritual. The same steps each night, such as warm drink, quiet music, a hand massage, a favourite blanket, signal that the day is ending.

How you respond in the moment

11. Stay calm and don't argue. Approach slowly, speak softly, and accept the feeling behind what they say. "You're worried. I'm here with you." Arguing almost always makes agitation worse. Never use physical restraint.

12. Redirect with something soothing. A snack, a short walk around the house, looking at old photos, folding laundry, or a song they love can shift their attention.

Keep a sundowning diary

For two weeks, jot down:

• What time the agitation started
• What happened just before (a nap, a visitor, a noisy TV, a missed snack)
• What helped and what didn't

Patterns often appear quickly. You might find that agitation always starts after a long nap, or eases when you put the lights on at 4 pm.

A sample calm evening routine

Here is one example you can adapt. Change the times to fit your loved one's usual pattern.

The point isn't to follow a clock perfectly. It's to make each evening feel familiar, so your loved one knows what comes next without having to remember it.

When to talk to a doctor

Speak to a doctor if:

• Confusion suddenly gets much worse over hours or days. This can be delirium, often caused by an infection such as a urinary tract infection, or by dehydration, and needs prompt medical help.
• Your loved one seems to be in pain or unwell.
• Sleep problems are severe. Conditions such as restless legs or sleep apnoea can make nights worse and can be treated.
• You think a medicine may be affecting their behaviour.

Non-drug approaches are usually tried first. The US National Institute on Aging notes that sleep medicines can raise the risk of dizziness, falls and confusion in older people, so any medicine should be discussed carefully with the doctor.

Look after your own evenings

Sundowning often hits when the caregiver is most tired, too. If you can, ask another family member to cover one or two evenings a week. Take five minutes outside, or a few slow breaths, before the hardest hour starts. You are allowed to need rest.