Reviewed for accuracy by Julian O’Campo, Founder of Lux Senior Care · Last reviewed
Sundowning is most common in the middle and later stages of dementia, often around stages 5 and 6 on the 7-stage scale, though it can start earlier. It shows up as confusion, anxiety, pacing, or agitation that builds in the late afternoon and evening. A steady routine, daylight, and a calm evening often help.
If the late afternoon has become the hardest part of the day in your home, you are not imagining it. Many families notice that a loved one with dementia is calmer in the morning and more confused, restless, or upset as the light fades.
This guide explains what sundowning means, what stage of dementia it usually appears in, what triggers it, and the routines and support that make evenings easier.
Sundowning, sometimes called sundown syndrome or late-day confusion, describes a pattern of increased confusion, anxiety, agitation, or restlessness that begins in the late afternoon and can continue into the night. It is not a separate disease. It is a group of symptoms that often accompanies Alzheimer’s disease and other types of dementia (Mayo Clinic).
In older adults, sundowning most often appears alongside dementia. But late-day confusion can also come from delirium, an infection, a medication, or poor sleep. Any sudden change in an older person’s thinking or behavior deserves a call to the doctor.
Sundowning is most common in the middle stage of dementia and often continues into the later stages. On the 7-stage Global Deterioration Scale that many doctors use, that usually means stages 5 and 6, when a person needs help with daily activities and memory gaps grow. Some people begin to show late-day changes earlier.
| Stage | What sundowning can look like |
|---|---|
| Early (stages 3 and 4) | Late-day fatigue, irritability, and trouble with evening tasks |
| Middle (stages 5 and 6) | Evening confusion about time or place, pacing, asking to “go home,” suspicion, trouble settling at bedtime |
| Late (stage 7) | Restlessness or distress late in the day, disrupted sleep, a strong response to comfort, touch, and a calm room |
Every person moves through dementia differently. Learn what to expect at each step in our guide to the stages of dementia.
Sundowning behavior can look different from one evening to the next. Common signs include:
Sundowning in elderly loved ones often follows a pattern, and caring for a sundowning elderly parent is easier once you know it. For a week or two, jot down when restlessness starts, what happened before it, what helped, and how the night went. Patterns, such as agitation after a long nap or a busy afternoon, point to changes you can make. Bring the log to the next doctor’s visit.
The exact cause isn’t known, but these factors can make late-day confusion worse (Mayo Clinic):
Busy late afternoons can add to it, too: visitors arriving, the TV on, dinner preparations, and family members coming home all at once.
Some medicines can cause or add to confusion in older adults, which can make sundowning worse. Examples include certain sleep aids and allergy medicines that contain diphenhydramine, some anxiety and sleep medicines, some bladder-control medicines, and opioid pain relievers. Mayo Clinic notes that a medicine side effect, pain, depression, or another condition can contribute to sundowning (Mayo Clinic).
Never stop or change a medicine on your own. Instead, bring a full list of prescriptions, over-the-counter medicines, and supplements to the doctor or pharmacist and ask for a medication review. Ask specifically whether any of them could be adding to evening confusion.
Late-day confusion can happen without dementia. Common causes include delirium after surgery or a hospital stay, infections, dehydration, medication changes, and sleep problems such as sleep apnea. Unlike sundowning in dementia, delirium usually comes on quickly, over hours or days, and it needs prompt medical attention.
If an older adult becomes confused after a hospital stay, call the doctor and keep someone with them, especially at night. See post-hospital recovery care at home and our guide to temporary home care after surgery.
For communication tips, read how to talk to a parent with dementia and learn about validation therapy. Changes in sleep are common, too; see do people with dementia sleep a lot?
If wandering is a concern, add door chimes or alarms, use an ID bracelet, and keep a recent photo on hand.
Sundowning can wear down even the most devoted family caregiver, because it arrives just when everyone is tired. Extra help for those hours protects your loved one and your own health.
Lux Senior Care is a Florida-licensed nurse registry serving Palm Beach, Martin, St. Lucie, Indian River, and Okeechobee Counties. We refer pre-screened, independent caregivers matched to your loved one’s needs and schedule, including evenings and nights. Learn more about Alzheimer’s and dementia care at home.
Call the doctor if you notice:
Call 911 if your loved one or anyone else is in danger.
Sundowning usually begins in the late afternoon or early evening and can last into the night. Many families notice it starts around the same time each day, which makes it easier to plan calming activities and extra help for that window.
Sundowning is most common in the middle and later stages of dementia, so it often becomes more noticeable as the disease progresses. It can also come and go. A sudden worsening may signal an infection, pain, or a medication problem, so call the doctor.
Episodes vary from a short spell to several hours, often starting in the late afternoon and easing later at night. Keeping a log of when episodes start and end, and what happened before, helps the family and the doctor spot triggers.
Late-day confusion is the classic pattern, but people with dementia can become confused or agitated at any time of day, especially when tired, in pain, or in an unfamiliar place. If the pattern changes suddenly, talk to the doctor.
Mayo Clinic notes that some research suggests a low dose of melatonin may ease sundowning, alone or combined with daytime bright light. Talk with the doctor before trying melatonin or any supplement, especially if your loved one takes other medicines.
Not usually. Sundowning is most common in the middle and later stages, and many people experience it years before the final stage. End-stage dementia is marked by other changes, such as very limited speech and needing help with nearly all daily care.
A referred caregiver for the late-afternoon and evening hours can bring calm, routine, and an extra set of hands. Lux Senior Care can refer pre-screened, independent caregivers matched to your loved one’s needs for evening, overnight, or around-the-clock help.
