It is 4:30 in the afternoon, and the day has gone well. Then something shifts. Your mother starts pacing from room to room. Your husband asks when the two of you are going home, though you are standing in your own kitchen. Voices get sharper, and the calm you counted on all day slips away.
If you feel dread as that hour approaches, you are in good company. This pattern has a name: sundowning. Sundowning in the elderly is common among people living with dementia, and families can often work with its causes.
You will know why evenings get harder and what you can do at home, starting tonight.
Common Sundowning Behaviors in the Evening
Sundowning is a pattern of worsening confusion, anxiety, agitation or restlessness that tends to appear in the late afternoon or evening. It is most often seen in people with Alzheimer's disease or another dementia. A person who chatted happily at lunch may seem suspicious, tearful or frightened by dinner. Some start gathering their belongings or insist they must leave for a job or a house they left years ago.
Sundowning behaviors vary from person to person. These are the ones families describe most often:
- Confusion that runs deeper than it did earlier in the day
- Pacing or wandering from room to room
- Agitation, or resistance when you try to redirect
- Shadowing, which means following a caregiver everywhere
- Asking to go "home," even while at home
- Trouble settling down for sleep
Sundowning is common, and it is nobody's fault. Estimates of how many people with dementia experience it range from roughly 1 in 40 to as many as 2 in 3, depending on the study and the setting. One study of people living at home found a rate at the high end of that range.
What Triggers Sundowning in the Evening
Researchers have not found a single cause. Several contributors seem to build on one another as the day goes on, and knowing them gives you things to adjust.
Tiredness and a shifted body clock. By late in the day, a person with dementia has spent a great deal of mental energy just getting through ordinary tasks. Dementia can also disturb the internal clock that signals when to be awake and when to sleep. Sleep trouble is common with age even before dementia is part of the picture: about 38% of adults over 65 have a sleep disturbance, with roughly 36% having trouble falling asleep and 29% having trouble staying asleep.
Fading light and long shadows. As the sun lowers, rooms dim and shadows stretch. A coat on a chair can look like a stranger. Shapes that seemed harmless at noon can frighten someone whose brain has trouble making sense of what the eyes see.
Unmet body needs. Hunger, thirst, a full bladder, constipation and pain can all raise restlessness. Your loved one may not be able to say what feels wrong. An infection can also bring on sudden confusion.
A full day and a changed routine. A morning of visitors, appointments and noise leaves little energy for the evening. A skipped meal or a shifted schedule adds to the strain.
Medication timing. The hour a medicine is taken can play a role. A doctor can review the schedule and make suggestions.
How to Manage Sundowning at Home: An Evening Routine
Small steps taken in the right order often make the biggest difference. Here is a routine you can begin today, built around the hours of the day.
Morning and early afternoon
Fill the first half of the day with light and movement. Open the curtains early, have breakfast near a bright window, and take a walk outside when the weather allows. Natural daylight helps the body clock keep its rhythm.
Make lunch the bigger meal of the day so dinner can be lighter. Offer caffeine only in the morning, and keep any afternoon rest short.
Mid-afternoon
Begin winding down around 3:00. Offer a snack and a glass of water, since hunger and thirst can build up without anyone noticing. Move to quieter activities, and do them in the same order each day. A predictable pattern lets your loved one know what comes next without having to ask.
As the sun goes down
Turn the lamps on before it gets dark, so the room never changes suddenly. Close the curtains at dusk so the windows do not turn into dark mirrors. Use night lights in the hallway and bathroom. Soft, even light shrinks the shadows that cause so much worry.
Dinner and the evening
Serve dinner at the same time every day. Keep the television low or turn it off, since loud or upsetting shows can add to anxiety. Schedule visitors for the morning when you can, and save new places and outings for earlier in the day.
The hour before bed
Offer a quiet, familiar activity. Folding towels, sorting buttons, looking through a photo album or listening to music from your loved one's younger years all work well. Tasks that feel useful give restless hands something to do.
If agitation arrives anyway, lower your voice and slow your pace. Offer reassurance and a gentle touch if your loved one welcomes it. When your loved one asks to go home, try saying, "Tell me about your home." The feeling behind the question usually matters more than the address.
Sundowning and Dementia: When Evenings Need More Support
Sundowning arrives at the hour when family caregivers have the least left to give. People caring for someone with Alzheimer's or another dementia provide an average of nearly 31 hours of care a week, on top of work, children and their own health. An estimated two-thirds of dementia caregivers experience some form of sleep disturbance, and a restless evening often leads to a restless night. Feeling worn out by 5:00 makes complete sense.
Call the doctor if sundowning begins suddenly, grows much worse, or comes with fever, pain or other new symptoms. A doctor can check for infection or pain and can review medications and sleep aids.
Some families find that routines help but the evenings still ask too much of one person. Steady evening or overnight support often changes the pattern in a way that one more tip cannot. At Queen City Elder Care, our owners and management team are Certified Dementia Practitioners, and our Director of Client Services is a Certified Alzheimer's Disease and Dementia Care Trainer. Our caregivers stay awake through overnight shifts so they can respond quickly when a client needs help.
If evenings have become more than your family can carry, in-home Alzheimer's and dementia care brings late-day and overnight support into the home your loved one knows. When what you need most is a few hours of rest, in-home respite care can give you that break. You can reach our team through Contact Us to talk about what your evenings look like.
Quick Answers
Does sundowning get worse over time?
It varies with the person and the underlying condition. Some people have more difficult evenings as dementia progresses, and others see the pattern ease. Steady routines, good light and attention to pain or illness often make it more manageable.
Is sundowning only in people with Alzheimer's disease?
Sundowning also occurs with other dementias. It is most often described in people with Alzheimer's disease, so most of what families read about it centers there.
What time of day does sundowning usually start?
It usually begins in the late afternoon or early evening, often as the light fades. The exact time differs from person to person. Jotting down when it starts for your loved one helps you time the routine above.
If you or an aging loved one is considering In-Home Alzheimer’s and Dementia Care in Cincinnati, OH, please contact the caring staff at Queen City Elder Care today at (513) 510-4410
Queen City Elder Care provides Home Care in Cincinnati, Hyde Park, Indian Hill, Madeira, Montgomery, Amberley, Anderson, Loveland, Mason, Wyoming, and surrounding areas.
Michele Vollmer is a visionary leader who is perpetually searching for ways to improve, so to remain at the leading edge of the home care industry.She has served in the healthcare industry since 1989, including pharmaceutical and home health sales, as well as hospice sales and sales management
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