Sundowning Syndrome: Why Dementia Symptoms Get Worse in the Evening

If you care for someone with dementia (like Alzheimer’s disease), you might notice that they:

• Get more confused in the late afternoon or evening

• Become restless, anxious, or upset as the sun goes down

• Pace, wander, or have trouble settling down at night

  
  

This pattern is called sundowning or sundowning syndrome (National Institute on Aging [NIA], 2024; Alzheimer’s Association, 2024; Mayo Clinic, 2023).

Sundowning can be very stressful for the person living with dementia and for caregivers. Understanding it can help you respond with more confidence and compassion.

What Is Sundowning Syndrome?

Sundowning is not a separate disease.

It is a group of symptoms that:

• Usually appear in the late afternoon, evening, or night

• Happen most often in people with Alzheimer’s disease or other dementias

• Involve changes in mood, behavior, and thinking as daylight fades (NIA, 2024; Alzheimer’s Association, 2024; Mayo Clinic, 2023)

  
  

Common changes include:

• More confusion or disorientation

• Agitation or irritability

• Restlessness, pacing, or wandering

• Ignoring directions or arguing

• Sometimes hallucinations or seeing things that are not there (Alzheimer’s Society, 2023; WebMD, 2023)

  
  

Some families say things like:

“They were fairly calm most of the day, but when the sun went down, everything changed.”

Who Usually Gets Sundowning?

Sundowning mostly affects people who already have:

• Alzheimer’s disease

• Other types of dementia

  
  

It can happen at any stage of dementia but is often seen more in the middle and later stages (Alzheimer’s Society, 2023; Verywell Health, 2025).

Studies suggest that somewhere between about 1.6% and up to 66% of people with dementia may experience sundowning symptoms, depending on the setting and how it is measured (Volicer et al., 2001; Kłapcińska et al., 2024; Jankowiak-Siuda et al., 2024).

What Does Sundowning Look Like?

Not every person looks the same, but common signs of sundowning include (NIA, 2024; Alzheimer’s Association, 2024; Mayo Clinic, 2023):

• Increased confusion in the late afternoon or evening

• Anxiety or fear, especially as it gets dark

• Agitation or aggression – yelling, resisting care, or arguing

• Pacing or wandering – can’t sit still, walking back and forth

• Restlessness – fidgeting, picking at clothes or blankets

• Shadowing – following a caregiver from room to room

• Problems falling asleep or staying asleep

• Calling out or asking the same questions repeatedly

  
  

These symptoms may come and go. Some evenings are worse than others.

Why Does Sundowning Happen?

Experts are still learning about sundowning, but research suggests it has many causes working together (NIA, 2024; Volicer et al., 2001; Jankowiak-Siuda et al., 2024; Kłapcińska et al., 2024).

Possible factors include:

• Changes in the body’s internal clock (circadian rhythm)

  • Dementia can damage parts of the brain that control sleep–wake cycles.

• Tiredness at the end of the day

  • The person may simply be exhausted, and their brain has fewer “resources” left to cope.

• Low light and shadows

  • As it gets darker, shadows and reflections can be confusing or frightening.

• Too much noise or activity late in the day

• Hunger, thirst, pain, or needing the bathroom

• Medication effects or interactions

• Poor sleep at night or daytime napping that throws off sleep rhythms

  
  

Because many different things can contribute, it often helps to look for patterns:What was going on right before the symptoms got worse?

What Caregivers Can Do to Help

There is no single cure for sundowning, but many small steps together can make a big difference (NIA, 2024; Alzheimer’s Association, 2024; Mayo Clinic, 2023; WebMD, 2023).

1. Keep a Regular Daily Routine

Try to:

• Wake up, eat meals, and go to bed at similar times each day

• Schedule bathing, appointments, or changes earlier in the day when the person has more energy

• Keep evenings quiet and predictable

  
  

A simple routine helps the brain feel safer and less overwhelmed.

2. Use Light to Your Advantage

• Open curtains during the day to let in natural light

• As the sun sets, turn on lights to reduce shadows

• A small night light in the hall or bathroom can reduce fear and confusion at night (Alzheimer’s Association, 2024; Mayo Clinic, 2023)

  
  

Good lighting can lessen misperceptions and reduce anxiety.

3. Create a Calm Evening Environment

In the late afternoon and evening:

• Reduce noise, such as loud TV or many people talking at once

• Avoid big arguments or heavy topics

• Offer calming activities:

  • Soft music

  • Looking at photos

  • Gentle hand massage or lotion

  • Folding towels or other simple, repetitive tasks

    
    

4. Watch Food, Drinks, and Naps

• Limit caffeine and alcohol, especially later in the day

• Avoid large, heavy meals right before bedtime

• Encourage a light snack if hunger seems to trigger agitation

• Try to limit long daytime naps, which can worsen nighttime sleep (NIA, 2024; WebMD, 2023)

  
  

5. Check for Pain, Illness, or Other Problems

Sometimes sundowning gets worse because of:

• Infections (like a urinary tract infection)

• Constipation

• Pain (arthritis, headaches, etc.)

• Medication side effects

  
  

If there is a sudden change in behavior or confusion, contact the person’s healthcare provider to check for new medical issues (NIA, 2024; Mayo Clinic, 2023).

6. Keep Yourself Safe and Supported

If the person becomes physically aggressive or keeps trying to leave the home:

• Make sure doors and stairways are as safe and secure as possible

• Remove or lock away dangerous items (knives, tools, matches)

• Talk to the healthcare team about:

  • Home safety

  • Respite care

  • When medications might be appropriate

    
    

And remember: Caregivers need care, too.Reach out to support groups, hotlines, or local dementia organizations for help and ideas (Alzheimer’s Association, 2024; NIA, 2024).

Tee Shirt: Education You Can Wear (Sundowning Awareness Tee)

Words on a screen are powerful—but education people can wear travels into homes, clinics, churches, and grocery store aisles.

That’s why NurseMob has a Sundowning Syndrome awareness tee designed to help caregivers and communities recognize this pattern in dementia.

A sundowning tee might highlight ideas like:

• “More confused after 4 p.m.? It could be sundowning.”

• “Evening restlessness, pacing, and agitation in dementia have a name—and strategies to help.”

• “Sundowning = late-day confusion, not ‘bad behavior’.”(NIA, 2024; Alzheimer’s Association, 2024; Mayo Clinic, 2023)

  
  

When someone wears this shirt to:

• A caregiver support group

• A memory care facility

• A family gathering

• Or just out in the community

  
  

it can:

• Start conversations:

  “What’s sundowning? My mom gets really restless in the evenings…”

• Help families realize that their loved one’s late-day agitation has a name and is a known dementia pattern

• Encourage people to ask nurses, doctors, or dementia specialists about strategies instead of blaming the person

  
  

The more Sundowning Syndrome tees out there, the more people:

• Hear that this is a real, recognized phenomenon

• Learn that environment, routine, and light can help

• Understand that they are not alone in struggling with evenings

  
  

You can find the sundowning awareness tee (and other dementia education apparel) in the NurseMob shop, created by a nurse to combine real information, caregiver support, and advocacy.

Sundowning Syndrome

From$18.00

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When to Call the Doctor or Seek Help

You should contact the person’s healthcare provider if:

• Sundowning suddenly gets much worse

• You notice new symptoms, like fever, pain, or change in walking

• The person falls, wanders away, or hurts themselves or someone else

• You, as the caregiver, feel overwhelmed or unsafe

  
  

In an emergency—such as chest pain, trouble breathing, serious injury, or immediate danger—call 911 (in the U.S.) or local emergency services.

Key References

Alzheimer’s Association. (2024). Sleep issues and sundowning.

Alzheimer’s Society. (2023). Sundowning and dementia.

Alzheimer Society of Canada. (2020). Restlessness or confusion, especially later in the day.

Jankowiak-Siuda, K., et al. (2024). Sundowning syndrome in dementia: Mechanisms, diagnosis, and treatment. Journal of Clinical Medicine, 14(4), 1158.

Kłapcińska, B., et al. (2024). Sundowning in patients with dementia: Prevalence and clinical features. Journal of the Neurological Sciences, 451, 120–130.

Mayo Clinic. (2023). Late-day confusion in people with dementia (sundowning). 

National Institute on Aging. (2024). Coping with agitation, aggression, and sundowning in Alzheimer’s disease and Tips for coping with sundowning. 

Volicer, L., et al. (2001). Sundowning and circadian rhythms in Alzheimer’s disease. American Journal of Psychiatry, 158(5), 704–711.

WebMD. (2023). Signs and symptoms of sundowning syndrome.

Verywell Health. (2025). What stage of dementia is sundowning?