Sundowning is confusion and restlessness in a person with dementia that builds from late afternoon into the night. The first thing to change is the light: brighten the house well before dusk, so the evening has fewer shadows.
After that, adjust the timing and pace of the day. The changes below are in the order worth trying.
Sundowning is a pattern of symptoms, not a separate illness
Treat sundowning as a pattern tied to the time of day, not a new condition. The Alzheimer's Association describes it as increased confusion from dusk through the night, and says it is not a disease on its own. Symptoms can include trouble sleeping, anxiety, agitation, hallucinations, pacing and disorientation.
The same page lists several things that can feed into it. A full day can leave a person exhausted. Low light creates shadows. A mixed-up body clock plays a part, and so does sensing stress in the people nearby.
Start a note on your phone today. Write down when the restlessness starts, what was happening just before, and what calmed it. Patterns are much easier to spot on paper than from memory.
Check for a physical cause before you change the house
Rule out something physical first, because agitation usually happens for a reason. The National Institute on Aging lists pain, constipation, too little rest and a sudden change of place, routine or person among the causes. Depression, stress, loneliness and medication effects are on that list too.
Here is what to check this week:
- Watch for wincing, rubbing a joint, or trouble getting comfortable in a chair.
- Keep a quiet eye on bathroom habits, in a way your parent is comfortable with.
- Note how last night went and whether today ran long.
- Think back over recent changes: a hospital stay, a new helper, a trip away, or moved furniture.
- Bring a written list of current medicines to the next appointment so the doctor can review it.
It's easy to rearrange a whole room while a sore tooth goes unnoticed. Check the body first.
Light the house brightly before dusk, not after it
Turn the lamps on in mid-afternoon, while it is still light outside. The Alzheimer's Association names low lighting that increases shadows as a contributing factor and suggests keeping the home well lit in the evening.
Shadows matter because they turn ordinary things into puzzles. In dim light, a coat on a hook or a pattern on the rug is harder to read. For someone already confused, a shape that won't make sense can be unsettling.
Walk through the house yourself at dusk. Sit where your parent sits and look around. Notice the dark corners and the gaps between lamps. Check for glare on shiny floors and the path to the bathroom.
- Add a lamp to each dark corner of the room your parent uses most.
- Put plug-in night lights along the hallway and in the bathroom.
- Close the curtains once it's dark, so windows don't become black mirrors.
One common mistake is relying on a single bright ceiling light. It throws hard shadows. Several lamps spread around the room give softer, more even light.
Move bathing, appointments and outings to the morning
Put the most demanding parts of the day before lunch. The Alzheimer's Association suggests scheduling appointments and bathing in the morning, when a person is less worn out.
When you book a clinic visit, ask for the earliest slot. Plan shopping trips, haircuts and family outings for the morning too.
Bathing is personal, so talk it through with your parent. Some people have showered at night all their lives. A warm washcloth in the evening and a full shower in the morning can be a fair middle ground. A shower chair and a grab bar (grab rail) can make a morning wash less tiring.
This plan doesn't suit everyone. If your parent wakes slowly and is foggy early, aim for late morning instead.
Turn things down from late afternoon
From late afternoon, cut the noise and the number of things happening at once. The Alzheimer's Association suggests reducing evening stimulation such as TV, chores and loud music. Too much noise, confusion or too many people in the room appear on the National Institute on Aging's list of causes.
Things to turn off or move earlier:
- The TV news, especially when it runs in the background.
- Talk radio and loud music. Swap in quiet music your parent already likes.
- Phone ringers and alerts in the room where your parent sits.
- Vacuuming, laundry and other noisy chores.
Visitors count too. If relatives drop in after work, ask them to come at lunchtime or keep the group small. Clear the clutter from tables and chairs in the evening room, so there is less to take in.
Serve a bigger lunch and a lighter supper
Make lunch the main meal of the day and keep supper small. The Alzheimer's Association suggests this, along with reducing alcohol, caffeine and nicotine.
Move the cooked meal to midday. Supper can be something simple and familiar. Cut coffee, strong tea, cola and alcohol after lunch.
Keep the habit and change what's in the cup. A decaf in the usual mug can keep the afternoon ritual intact. If your parent smokes, that is their choice and a conversation for them and their doctor.
Get daylight in the morning and keep naps in check
Get your parent outside in daylight during the day, and keep daytime naps limited. Both are suggestions from the Alzheimer's Association, and the National Institute on Aging also mentions natural light during the day.
Small steps count. Have breakfast by the brightest window. Walk to the mailbox together, or sit on the porch with a drink.
Rest still matters, so offer a quiet break after lunch. The usual mistake is letting a long doze in the armchair drift into late afternoon. Bring a nap to a gentle end by opening the curtains, offering a drink and putting on some music.
Have a script ready for when it starts
When the restlessness starts, lower your voice, reassure, and steer toward something calm to do. Reasoning rarely helps in that moment. Redirection usually works better.
- Slow down and speak softly.
- Name what you see: "You look worried."
- Reassure: "You're safe. Everyone's fine."
- Offer a hand or an arm, if your parent welcomes touch.
- Suggest something to do: a snack, a short walk, or a job together.
The folding-laundry trick comes from the National Institute on Aging's list of shared chores. Keep a basket of clean towels by your parent's chair. Ask, "Could you help with these?" and fold alongside them.
The folding doesn't need to be neat. Never refold anything in front of your parent. The job is about busy hands and company, not tidy towels.
Photos and soothing music can help as well. A small album of familiar faces works well kept within reach of the evening chair.
What makes evenings worse: arguing, correcting and rushing
Don't argue, correct or hurry your parent once the evening turns. The National Institute on Aging advises speaking calmly and not arguing. It also lists being pushed to do something difficult as a cause of agitation.
Correcting facts is the trap most families fall into. Telling your parent that their mother died years ago won't settle anything. Respond to the feeling instead: "You miss her. Tell me about her."
Blocking a doorway or holding an arm can turn a worried moment into a struggle. Give space, remove anything risky, and stay close. Lock up the car keys if driving off is a real risk.
Your own mood counts. The Alzheimer's Association lists noticing stress in others as a contributing factor. If you feel your jaw tighten, step into the next room for a minute, if it's safe, and breathe.
Call the doctor when something changes suddenly
Call your parent's doctor if evenings get noticeably worse over a few days, or if the agitation comes with signs of illness or pain. Ring sooner after any new medicine or change in dose.
Also call if hallucinations are new, if nobody in the house is sleeping, or if your parent seems unwell in themselves. Bring your notes to the appointment. If anyone is in danger, call emergency services.
If the difficulty is hearing rather than memory, talking with a parent who has hearing loss covers the room and the phrasing. For walking and doorways, see a Parkinson’s morning, room by room.
Common questions
Is sundowning a sign the family is doing something wrong?
No. The contributing factors include end-of-day tiredness and a mixed-up body clock, and neither is your doing. You're in large company: nearly 13 million Americans provide unpaid care for a family member or friend with dementia.
Should we buy lamps or night lights first?
Start with lamps for the room your parent uses in the evening, because dusk is when trouble starts. Add night lights next, along the route to the bathroom.
What do we say when Mom asks to go home, and she is home?
Don't correct her. Try "Tell me about home," then offer a snack or a short walk together. The wish to go home is often about wanting to feel safe, so reassurance tends to work better than facts.
Is it okay to leave the TV on for company?
In the evening, it's better to switch it off or choose something slow and familiar. News and loud shows add the kind of stimulation worth cutting after late afternoon. Quiet music your parent likes can fill the silence instead.
This article is general information, not medical advice. Please talk with your parent's doctor about their health.
