What Is Sundowning?

What is sundowning?

Sundowning refers to a worsening of symptoms later in the day, rather than a separate medical condition. Someone experiencing sundowning may appear relatively settled during the morning and early afternoon, then become increasingly confused or unsettled as evening approaches.

Sundowning can involve emotional, behavioural and physical changes. These are not deliberate actions, but expressions of distress, fatigue or confusion. Understanding this can help families respond with reassurance rather than frustration.

Guidance from the Alzheimer’s Society and information provided by the NHS recognise sundowning as a common experience for people living with dementia.

 

Common signs and symptoms

Sundowning affects each person differently, but common signs may include:

Emotional changes

• Increased anxiety or fear
• Low mood or tearfulness
• Irritability or emotional sensitivity

Behavioural changes

• Restlessness or pacing
• Repetitive questioning
• Calling out or seeking reassurance
• Resistance to personal care
• Increased confusion about time or place

Physical and sleep related changes

• Difficulty settling in the evening
• Disrupted sleep patterns
• Day and night confusion
• Increased wandering risk

Symptoms often follow a similar daily pattern, which can make evenings particularly challenging for family carers.

 

Why does sundowning happen?

There is no single cause of sundowning. Instead, it is thought to result from a combination of neurological, physical and environmental factors.

Changes in the body clock

Dementia can affect the brain’s ability to regulate circadian rhythms. As a result, the natural signals that distinguish day from night may become less clear.

Fatigue and cognitive overload

By late afternoon, many people are mentally and physically tired. As energy levels drop, coping mechanisms weaken and confusion can increase.

Reduced lighting and visual changes

As daylight fades, shadows lengthen and familiar spaces can appear unfamiliar. This can increase anxiety or lead to misinterpretation of surroundings.

Unmet physical needs

Hunger, thirst, pain, constipation or discomfort may become more noticeable in the evening, particularly if communication is difficult.

Environmental triggers

Noise, busy households, visitors or changes in routine later in the day can contribute to agitation and restlessness.

Understanding individual triggers is an important step in reducing distress and supporting calmer evenings.

 

Who is most affected?

Sundowning is most often associated with:

• Alzheimer’s disease
• Vascular dementia
• Lewy body dementia
• Mixed dementia

Not everyone living with dementia will experience sundowning, and the severity can vary over time. Symptoms may fluctuate, improving or worsening depending on health, environment and routine. Events such as illness, hospital stays or moving away from familiar surroundings can sometimes make sundowning more noticeable.

 

The emotional impact on families

Sundowning can be distressing not only for the individual, but also for the people supporting them. Families often describe evenings as tense or exhausting, especially when reassurance is needed repeatedly or sleep becomes disrupted.

Over time, this can lead to emotional strain and fatigue for family carers. Recognising the impact on your own wellbeing is important. Support is not about replacing family involvement, but about strengthening it and ensuring care remains sustainable.

 

Supporting someone with sundowning at home

While sundowning cannot always be prevented, many families find that consistency, calm and reassurance can significantly reduce distress.

Establishing a steady daily routine

Predictable routines help create a sense of security. Regular times for meals, activities, rest and bedtime can reduce anxiety as the day progresses.

Supporting daylight exposure and activity

Exposure to natural daylight and gentle daytime activity may help regulate sleep patterns and reduce restlessness later in the day.

Creating a calm evening environment

• Gradually increase lighting as daylight fades
• Reduce background noise and visual clutter
• Avoid overstimulation from television or busy household activity
• Keep surroundings familiar and uncluttered

Offering reassurance rather than correction

When confusion increases, correcting facts can sometimes increase distress. Calm reassurance, validation and distraction are often more effective.

Supporting comfort and wellbeing

Ensuring comfort, hydration and appropriate support with pain or discomfort can make a noticeable difference to evening behaviour.

 

How live in care can help with sundowning

For many families, sundowning is one of the reasons they explore live in care. Having a dedicated carer in the home provides reassurance and practical support during the most challenging times of day.

Continuity and familiarity

A consistent carer builds trust and understands individual routines, preferences and triggers. This continuity is particularly valuable during evenings and nights.

Calm companionship

A live in carer offers gentle companionship and emotional reassurance, helping to reduce feelings of isolation, fear or agitation.

Support through the night

Sundowning does not always stop at bedtime. A live in carer can provide reassurance, support with personal needs and help ensure safety if someone wakes during the night.

Reduced pressure on family members

Knowing that experienced support is in place allows families to rest, reducing exhaustion and helping them remain emotionally resilient.

 

 

Remaining at home

Staying in familiar surroundings can significantly reduce confusion. Live in care supports independence while avoiding the disruption that can come with residential moves.

 

When to seek further advice

If sundowning symptoms suddenly worsen, or appear alongside new physical symptoms, it is important to seek advice from a GP or healthcare professional. While this guide does not provide medical advice, changes can sometimes be linked to treatable causes such as infection or discomfort.

Organisations such as Age UK and the Alzheimer’s Society can also offer guidance, practical information and emotional support for families.

 

Reassurance for the future

Sundowning can feel overwhelming, but many families find that with the right understanding and support, evenings become more manageable. Small adjustments, consistency and compassionate care can make a meaningful difference.

Live in care offers a flexible, personalised approach that evolves as needs change, supporting both the individual and the people who care about them.

 

How we can support you

If sundowning is affecting your loved one, you do not have to manage it alone. With the right support in place, evenings can become calmer, safer and more reassuring for everyone involved.

As a specialist provider of live in care, we support individuals to remain in the comfort of their own home, with care that adapts to changing needs and routines. Our experienced carers understand the challenges of sundowning and provide steady, compassionate support during the times of day that can feel most difficult.

Whether you are exploring care for the first time or looking for additional support, we are here to help.

 

Speak to our care team

Our friendly care specialists can talk through your situation, answer your questions and explain how live in care could work for you or your family member.

There is no obligation, and every conversation is handled with understanding, professionalism and discretion.

Contact us today to arrange a confidential conversation about live in care at home on 0345 125 8974