Sundowning in Dementia: What It Is, Why It Happens & How to Manage It

What is sundowning?

Sundowning is a pattern of increased confusion, anxiety, agitation, or restlessness that occurs in older adults, with or without dementia, during the late afternoon, evening, or night. “Sundowning” is not a formal psychiatric diagnosis; it is a widely recognized clinical pattern seen by caregivers, hospital staff, and long-term care providers.

Sundowning is defined in the clinical literature as:

A set of neuropsychiatric symptoms, including confusion, disorientation, anxiety, agitation, aggression, pacing, wandering, resistance to redirection, and yelling, that occur specifically in the late afternoon, evening, or night. What distinguishes sundowning from related conditions like delirium or general dementia symptoms is this specific time-of-day pattern¹.

Sundowning is thought to be caused by a combination of factors, including

• extreme fatigue,
• late-day changes in lighting and shadows,
• unmanaged pain,
• vision problems,
• hunger or thirst, and
• depression.

Being the caregiver for someone experiencing sundowning can be stressful and exhausting. When a loved one shows signs of sundowning, the best first step is to figure out what is triggering their symptoms. This will help you determine what to try changing about their environment or behavior. Below are some approaches to try.

Environmental Approaches

Adjusting the immediate environment can reduce the triggers that contribute to sundowning:

• Maximize daytime light exposure by keeping window coverings open during the day
• Eliminate shadows at dusk by closing window coverings and turning on lights before shadows can form. Shadows are a common source of confusion for people with dementia.
• Build a calm evening routine by taking an early evening walk or playing calming background music. This helps to signal a predictable transition.
• Reduce loud or sudden noises. Banging pots, alarms, or sudden sounds can trigger agitation.
• Add gentle background (white) noise. Low, steady background noise can soften the impact of sudden sounds.
• Minimize clutter in the spaces where your loved one spends time.
• Limit the number of people in the room.
• Monitor TV content. Many programs, including news, can be upsetting for someone with dementia.

Behavioral Approaches

• Keep a stable daily routine. Predictability is comforting and reduces anxiety about what is coming next.
• Give simple, one-step instructions for meals, bathing, and other tasks.
• Reduce or cut out caffeine and alcohol, especially later in the day.
• Keep naps short and earlier in the day rather than in late afternoon.

Responding to Sundowning as it Happens

• Listen first. The source of their fear or agitation isn’t always obvious. A shadow, sound, or other stimulus could be the trigger. Keep listening and try different things to help them calm down.
• Redirect with a familiar task. Fold laundry, even if it’s already been folded. Start dinner early if they are hungry. Go for an evening walk if that is an activity they enjoy. TV or radio can also help redirect attention, but you should take care to monitor the content.
• Use gentle touch. Holding a hand, giving a hug, or a reassuring hand on the back can be calming and reassuring.

Frequently asked questions

What causes sundowning?

Research points to a mix of factors: disruption of the brain’s circadian clock, fatigue accumulated over the day, late-day light and shadow changes that cause visual confusion, unmet needs like hunger or pain, and overstimulation from earlier activity² can all contribute to sundowning.

How long does sundowning last?

Episodes typically last a few hours around sunset. Reported prevalence and duration vary widely across studies (from about 2.5% to 66% of people with dementia), depending on the setting and how sundowning is defined. This reflects how inconsistently the condition has been measured to date.

Does sundowning get worse over time?

It can fluctuate, and sundowning has been associated with faster cognitive decline and greater impacts on caregivers over time³. Environmental and routine-based strategies can still help reduce severity at any stage⁴.

Is sundowning the same as delirium?

Not exactly, though the two can be hard to tell apart. Some researchers describe sundowning as a “delirium-like” condition tied specifically to the sunset hour, while true delirium is an acute, fluctuating disturbance in attention that can occur at any time and usually has an identifiable medical trigger³. Because the conditions can overlap, sudden or severe changes in confusion should be evaluated by a doctor to rule out delirium or another underlying medical cause.

What should I do when sundowning starts?

Listen for the underlying cause, redirect with a calming or familiar activity, and use gentle touch to reassure. Avoid arguing or over-explaining, which can increase agitation.

Can medication help with sundowning?

Behavioral and environmental strategies are recommended as the first-line approach; no randomized controlled trial has yet established a specific pharmacological treatment for sundowning itself.

In April 2026, the drug Auvelity was approved for agitation associated with dementia due to Alzheimer’s disease. Agitation is a more general condition that can occur at any time during the day, not just in the window when sundowning occurs. It is also important to note that Auvelity is meant to be taken on a regular schedule and not on an “as-needed” basis.

If symptoms are severe, persistent, or sudden in onset, a physician should check for underlying causes such as pain, infection, sleep disorders, or medication side effects, and discuss whether medication is appropriate.