Sundowning in Dementia: Causes, Symptoms, and Proven Ways to Help
- Nestcare Home Care and Private Duty Nursing
- May 11
- 4 min read
How to calm the chaos at the end of the day—and restore peace for both of you
In this blog we will discuss: sundowning dementia help, dementia evening agitation, Alzheimer’s sundowning help, dementia behavioral changes, sundowning solutions at home
“She’s fine all day—then suddenly everything falls apart…”
If you’re caring for someone with dementia, this may sound painfully familiar.
The day goes well enough. You manage meals, medication, and maybe even a walk or two.
Then late afternoon hits, and like flipping a switch:
They get anxious, confused, or irritable
They pace the house
They shadow you room to room
They accuse you of things
They ask to “go home” even though they’re already there
You’re exhausted, they’re upset, and your evening spirals before it even starts.
This isn’t your fault.It’s called sundowning—and it’s a real, medically recognized symptom of dementia.
Let’s break down what causes sundowning, how to spot it, and the proven ways to make evenings more peaceful—for both of you.
What Is Sundowning in Dementia and What Can Help?
Sundowning refers to a pattern of increased agitation, confusion, anxiety, or aggression that occurs in the late afternoon or evening in people with dementia—especially Alzheimer’s disease.
It doesn’t happen to every dementia client, but when it does, it’s disruptive and distressing for everyone involved.
Common Signs of Sundowning
You might notice:
Restlessness, pacing, or fidgeting
Verbal outbursts or mood swings
Shadowing (following you closely)
Asking repetitive questions
Expressing fear, confusion, or wanting to “go home”
Increased confusion about time or surroundings
Sleep disruptions later at night
Sundowning behaviors can range from mild unease to full-blown agitation—and they often peak around 4–8 p.m.
What Causes Sundowning?
While the exact cause isn’t fully understood, researchers believe sundowning is triggered by a combination of:
🕰️ Disruption of Circadian Rhythms
The brain’s internal clock, which tells us when to sleep and wake, becomes damaged in dementia—leading to confusion as daylight fades.
😵 Sensory Overload or Fatigue
After a full day of stimulation, the dementia brain is tired, overwhelmed, and unable to regulate as well.
🌇 Lighting Changes and Shadows
Dim light and evening shadows can distort the environment, making things feel strange or unsafe.
😰 Anxiety About the Unknown
As the day ends, your loved one may sense that something is “off”—but can’t explain why. This confusion often leads to fear-based behaviors.
How to Reduce Sundowning: Proven Strategies That Work
✅ 1. Stick to a Consistent Daily Routine
Predictability creates safety. Keep meals, medications, walks, and rest at the same times every day.
Tip: Use visual routines or daily Nest Care Cards to build structure without pressure.
✅ 2. Reduce Stimulation Later in the Day
Dim the lights, turn off the TV, and switch to calm music or a quiet activity. Create a peaceful evening environment.
✅ 3. Avoid Long Naps or Excess Caffeine
Too much sleep during the day—or stimulants after noon—can confuse the body’s natural rhythm.
✅ 4. Use Gentle Movement Before Dinnertime
Light movement helps release built-up tension and promotes regulation.
Try:
Chair exercises
Slow dancing to music
Sock toss or a light walk
Movement Cards from Nest Care make this simple and safe to do at home.
✅ 5. Engage Their Hands and Minds
Sundowning is often made worse by boredom or anxious energy.
Offer something simple and purposeful, like:
Folding towels
Matching socks
Watering plants
Doing a sensory-friendly activity from the Nest Care Cards Activity Deck
✅ 6. Validate, Don’t Correct
If they say, “I want to go home,” respond with:💬 “You’re safe here. I’ll stay with you.”
Avoid: “You are home, Mom!”(That only increases confusion.)
Redirection works better than reorientation—especially during evening confusion.
✅ 7. Limit Visitors and Tasks in the Late Afternoon
Too much activity can overload the brain. Save errands, visits, or therapy sessions for the morning whenever possible.
✅ 8. Try a Pre-Bedtime Wind-Down Routine
Warm bath or foot soak
Aromatherapy (lavender, peppermint)
Calming Nest Care Conversation Card
Dim lighting, soft blankets, familiar music
When to Seek Medical Support
If sundowning behaviors escalate or become dangerous, talk to your physician about:
Pain
Medication interactions
Sleep disorders
Anxiety or depression
Underlying infections
In some cases, medication adjustments may help, but often, behavioral strategies and structure make the biggest difference.
How Nestcare Can Help With Sundowning
At Nestcare, we understand how exhausting and emotional sundowning can be. That’s why we’ve created tools and services designed to reduce agitation and promote calm—without adding more to your plate.
Here’s how we can help:
Our Activity Deck, Conversation Cards, and Movement Cards offer over 100 low-prep, brain-friendly routines you can use at home—many designed specifically for evenings and late-day transitions.
No prep. No stress. Just structure, connection, and peace.
We can help you build a personalized sundowning support routine, adjust care plans, or provide in-home support to reduce evening agitation.
Through 1:1 guidance and resource planning, we help you feel less overwhelmed and more equipped to manage the emotional rollercoaster of caregiving.
Sundowning feels like the end of the rope for many caregivers. But with the right tools, timing, and tone, you can transform this difficult part of the day into something more manageable—even meaningful.
It’s not about doing everything perfectly.It’s about creating a rhythm that works—for both of you.
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