Compassionate Care: How to Handle Sundowning – Managing Evening Agitation in Dementia Patients
If your loved one with dementia becomes more confused, restless, or agitated in the late afternoon or early evening, you’re not imagining it. This pattern, commonly known as sundowning, affects many people with dementia—often catching caregivers off guard just when they’re winding down from a long day.
Sundowning can be emotionally exhausting for both you and your loved one. But with the right strategies and a deeper understanding of what’s happening, it is possible to reduce its impact and create more peaceful evenings.
In this post from Compassionate Care, we’ll explore what sundowning is, what causes it, common signs to look for, and gentle, practical ways to manage it with compassion and support.
🌅 What Is Sundowning?
Sundowning refers to a state of increased confusion, anxiety, agitation, or even aggression that tends to occur in the late afternoon, evening, or after sunset. It can last a few hours or continue through the night, leading to sleep disruptions and safety concerns.
While not every person with dementia experiences sundowning, for those who do, it often becomes a recurring part of their daily rhythm.
🔍 What Causes Sundowning?
The exact cause isn’t fully understood, but experts believe sundowning is related to a disruption in the body’s internal clock (circadian rhythm) and increased cognitive fatigue at the end of the day.
Common contributing factors include:
- Low light and shadows that cause disorientation or fear
- End-of-day exhaustion, both mental and physical
- Unmet needs, such as hunger, thirst, pain, or needing to use the bathroom
- Overstimulation or too much activity earlier in the day
- Changes in routine or a sense of uncertainty
- Fear or confusion as the environment becomes darker and quieter
🧠 What Sundowning Can Look Like
Sundowning varies from person to person, but here are some common behaviors you may notice:
- Pacing or wandering
- Increased restlessness or anxiety
- Yelling or resisting care
- Asking to “go home” even if they’re already there
- Hallucinations or paranoia
- Repetitive questioning or statements
- Trouble sleeping or staying asleep
These behaviors aren’t intentional—they’re signs that your loved one’s brain is having trouble processing what’s happening around them as the day winds down.
💡 How to Respond with Compassion and Calm
Sundowning can feel distressing and unpredictable, but your response can make a meaningful difference. Here are caregiver-tested strategies to reduce evening agitation:
🕯 1. Create a Calm, Predictable Evening Routine
A soothing, structured routine can help signal to the brain that it’s time to wind down.
What helps:
- Dim the lights gradually as the sun sets
- Use soft music, warm lighting, or a calming scent like lavender
- Keep evening activities quiet and familiar—think puzzles, folding laundry, or listening to music
- Avoid loud or jarring TV shows or overstimulating conversations
Real-life example:
Claire’s mother with mid-stage dementia became agitated every evening. They started turning off the TV at 5 p.m., dimming the lights, and playing her favorite instrumental music. Over time, the evenings became less tense.
🍽 2. Offer Light, Nutritious Snacks and Hydration
Low blood sugar or dehydration can contribute to restlessness. Make sure your loved one has:
- A light dinner (heavy meals may be harder to digest late in the day)
- A small snack if needed before bed—like a banana or piece of toast
- Plenty of fluids, especially water or herbal tea (limit caffeine and alcohol)
Tip: Avoid large amounts of fluid too close to bedtime to reduce nighttime bathroom trips.
🌞 3. Maximize Daytime Activity and Natural Light
A well-spent day often leads to a more restful evening.
What helps:
- Exposure to natural light early in the day (open the curtains or go outside)
- Short walks or chair exercises to use energy
- Avoid long naps late in the day—early afternoon naps are better if needed
Why this matters: A healthy day-night rhythm can help regulate your loved one’s internal clock.
🪞 4. Reduce Shadows and Reflections
As the light changes in the evening, shadows and reflections can be frightening or disorienting for someone with dementia.
What helps:
- Turn on lamps before sunset to keep lighting consistent
- Close blinds and curtains to reduce reflections in windows
- Cover or remove mirrors if your loved one is startled by their own reflection
🗣 5. Respond with Reassurance, Not Correction
If your loved one says they want to “go home” or insists on something that isn’t accurate, avoid arguing. Their distress is real—even if their perception isn’t.
Try saying:
- “You’re safe here.”
- “Let’s sit together for a while.”
- “We’ll go a little later. Right now, let’s have some tea.”
- “That sounds important. Tell me more about it.”
Avoid saying:
- “You are home.”
- “That’s not true.”
- “You already said that.”
Tip: Redirection is more effective than correction.
🛏 6. Prepare for Bedtime with Soothing Signals
Bedtime can be especially difficult during sundowning. Keep it gentle and reassuring.
Bedtime tips:
- Give plenty of time for transitions—don’t rush through the evening routine
- Use familiar bedding, pajamas, and scents
- Offer a nightlight to reduce fear
- Keep essential items visible (like water, tissues, or a photo of a loved one)
🧭 When Sundowning Feels Overwhelming
Even with all the right strategies, sundowning can still be tough. On especially hard days:
- Take a short break if it’s safe to do so
- Reach out to a friend, support group, or counselor
- Remember that you’re not failing—this is part of the disease, not your fault
If your loved one’s agitation becomes unmanageable or leads to unsafe behaviors, talk to their doctor. Medication is sometimes prescribed in extreme cases, but this decision should always be made with medical guidance and close monitoring.
⚠️ A Gentle Disclaimer
The information in this post is for general support and education. I do not prescribe or recommend any specific medications or treatments. What works for one person may not work for another, and any decisions about care plans or medications should be made in consultation with your loved one’s physician or dementia care team.
💙 Final Thoughts: Patience, Not Perfection
Sundowning can feel like one of the most frustrating parts of dementia care. You’re tired, your loved one is restless, and the evenings you once shared peacefully have changed.
But you’re not alone—and this phase doesn’t mean you’re doing anything wrong.
Sometimes all you can do is sit beside them in the discomfort, offer a gentle voice, and breathe through the moment. And that’s enough.
At Compassionate Care, we honor the effort it takes to show up day after day, especially when the sun starts to set. You are doing something incredibly hard—and incredibly meaningful.
