What is sundowning?

Sundowning is a pattern of increased confusion, restlessness, anxiety or agitation that appears in the late afternoon and evening in some people living with dementia. The name comes from the timing: symptoms tend to build as the sun goes down and the light fades. It is not a disease or a diagnosis in its own right, and it is not something the person is doing deliberately. It is a recognised pattern of behaviour that many families notice at the same time each day, often described as the person becoming "a different person after about four o'clock".

If you are caring for someone and you have started to dread the late afternoon, you are describing something very common, and there are practical things that genuinely help.

What sundowning looks like

It varies from person to person, but families commonly notice some combination of the following as the day ends:

• Restlessness, pacing, or an urge to leave the house
• Increased confusion about where they are or what time it is
• Anxiety, irritability or suspicion that was not present earlier
• Wanting to "go home", even when they are at home
• Difficulty settling to sleep, or waking through the night
• Shouting, resistance to help, or distress that seems out of proportion

The distinguishing feature is the timing. Someone may be settled and capable in the morning, then noticeably harder to support from mid-afternoon onwards. That daily rhythm is what separates sundowning from a general decline.

Why it happens

There is no single confirmed cause, but several factors are thought to contribute, and most are worth checking because several can be changed.

Tiredness and accumulated effort. Living with dementia takes constant mental work. By late afternoon the person has been compensating all day and the reserve is gone. Fatigue lowers everyone's tolerance; here it can tip into distress.

Changing light. Fading light and lengthening shadows make a familiar room harder to read. Shadows can be misinterpreted, and poor contrast makes it harder to recognise objects and faces.

Disrupted body clock. Dementia can affect the part of the brain that regulates the sleep and wake cycle, so the usual cues about time of day become unreliable.

Unmet needs that are hard to express. Hunger, thirst, needing the toilet, pain, constipation, or being too hot or cold can all drive agitation. When someone can no longer say "my hip hurts", the distress comes out as behaviour instead.

Too much going on. Late afternoon is often the busiest, noisiest part of the day in a household, with meals being made, the television on and people arriving home.

Medication timing. Some medications wear off or peak at particular times of day.

What helps

No single approach works for everyone, so treat these as things to try and observe rather than rules.

Keep the day predictable. A consistent rhythm of getting up, meals, activity and bed reduces the mental work of figuring out what happens next. Sameness is calming.

Bring the light forward. Turn lamps on before dusk rather than after, so the light does not drop suddenly. Close curtains to remove the transition entirely. Reduce glare and cover mirrors if reflections cause confusion.

Move activity earlier. Schedule appointments, showers, visitors and anything demanding for the morning, when the person has the most capacity. Keep late afternoon deliberately quiet.

Get daylight and gentle exercise earlier in the day. Morning light and a walk support the body clock and can improve sleep at night.

Check the simple things first. Before treating agitation as a dementia symptom, run through hunger, thirst, toilet, pain, temperature and noise. A snack, a drink or a trip to the bathroom resolves a surprising amount.

Watch caffeine, alcohol and long naps. A late-afternoon cup of tea or a long afternoon sleep can make the evening harder.

Do not argue with the reality. If the person insists they need to go home or collect the children, contradicting them usually escalates the distress. Acknowledge the feeling, offer reassurance, then redirect gently to something absorbing. You are responding to the emotion, not the facts.

Keep a simple diary for a week or two. Note the time, what happened just before, what the person had eaten and what helped. Patterns show up quickly on paper that are invisible in the moment, and it is genuinely useful information to take to a GP.

When to talk to a doctor

See a GP if the pattern appears suddenly, worsens quickly, or comes with other new symptoms. A sudden increase in confusion is not automatically dementia progressing. It can be delirium, which is a different thing, often caused by infection, pain, dehydration, constipation or medication, and it usually needs prompt medical attention. Urinary tract infections are a frequent and easily missed culprit in older people.

It is also worth asking for a medication review, since timing and side effects can contribute.

For advice at any hour, including for carers who are struggling, the National Dementia Helpline on 1800 100 500 is free and available 24 hours a day.

Looking after the carer

Sundowning is genuinely wearing, because it lands at the end of the day when you are least resourced. If the evenings are becoming unsustainable, that is a reason to get more support, not a sign that you are failing.

Respite care exists precisely for this, and can be arranged in your home, at a day centre, or as a short stay in a residential home. Carer Gateway on 1800 422 737 can talk through practical support and counselling. To arrange ongoing help at home, contact My Aged Care on 1800 200 422, or browse verified home care providers on Our Mate to see what is available near you.

Frequently asked questions

Is sundowning a normal part of dementia?

It is common but not universal. Many people living with dementia never experience it, and among those who do, the intensity varies and it may come and go over the course of the illness. It is a recognised pattern rather than an inevitable stage.

What time of day does sundowning usually start?

It typically begins in the late afternoon or early evening, often as natural light starts to fade, and can continue into the night. The exact timing differs from person to person, but it is usually consistent for the same person, which is what makes it recognisable.

Does sundowning happen in people who do not have dementia?

The term is used mainly in the context of dementia. Older people without dementia can become confused or agitated in the evening too, particularly in hospital, but that is more often delirium, which comes on suddenly and needs medical assessment.

Can medication stop sundowning?

There is no specific medication for sundowning, and non-medication approaches such as routine, lighting and checking for unmet needs are generally tried first. A doctor may review existing medications, since timing or side effects can contribute. Any medication for agitation needs careful medical supervision, particularly because some types of dementia react badly to certain drugs.

When should sundowning be checked by a doctor?

See a GP if it starts suddenly, worsens rapidly, or comes with new symptoms such as fever, pain or a sharp change in alertness. Those can indicate delirium from an infection or another treatable cause, which needs prompt attention rather than management at home.