Sundowning: Why Dementia Gets Worse in the Late Afternoon

By four in the afternoon she's somebody else. Restless, asking the same question for the ninth time, putting her coat on, certain she needs to get home while she's standing in the middle of her own living room. By eight the next morning she's calm and herself again, and the whole evening looks like it never happened.

If that sounds familiar, there's a name for it. Sundowning. It's common with dementia, it tends to show up in the middle stages, and it's the hardest hour of the day in a lot of households.

What sundowning actually is

Sundowning isn't a separate illness and it isn't your parent being difficult. It's a pattern where confusion, restlessness and agitation get noticeably worse in the late afternoon and evening, then ease overnight or by the next morning.

The shape of it varies. Some people pace. Some become suspicious, convinced somebody has taken something or that there's a stranger in the house. Some get fixed on leaving, which is where the phrase about wanting to go home comes from, even when they're already home. Others simply become tearful and can't say why.

What they share is the timing. It starts as the light goes, and it doesn't carry into the next day.

Why it happens when it happens

There's no single cause, which is part of why it's so hard to head off. Several things stack up at the same hour.

Fatigue. Holding a conversation, working out where you are, recognizing faces, remembering what you were doing. For somebody with dementia all of that takes effort, all day, with no real break. By late afternoon the reserve is gone.

Fading light. As rooms dim, shadows get harder to read. A coat over a chair becomes a person. A dark doorway becomes a hole in the wall. Reflections in a window at dusk look like somebody outside looking in.

The body clock. Dementia disrupts the internal rhythm that tells somebody when it's day and when it's night. The signal that should settle them in the evening doesn't arrive properly.

The day catching up. A busy afternoon, visitors, an appointment, noise, television. It may have gone fine at the time and still be too much by five.

Everybody else is tired too. This one matters more than people expect. The family member providing the care is at their most worn out at exactly the hour their parent needs the most patience, and people with dementia read tone and tension long after they stop following the words.

What helps

None of this stops sundowning. What it does is take the edges off, and over a few weeks that difference is real.

Turn the lights on before dusk, not after. Get ahead of the gloom rather than reacting to it. Bright, even light in whichever rooms are being used.

Close the curtains before it gets dark outside. That removes the reflections in the glass, which are a common trigger for believing somebody is out there.

Move the big meal earlier. A substantial lunch and something light in the evening tends to work better than the other way around. Hunger makes everything worse and it's easy to miss, because somebody with dementia often can't tell you they're hungry.

Keep caffeine to the morning. That includes tea and soda as well as coffee.

Put the demanding parts of the day in the morning. Appointments, showers, visitors, anything that takes effort. Protect the late afternoon and keep it quiet and predictable.

Watch the naps. A short rest after lunch is fine. A long one at four in the afternoon usually makes the evening and the night worse.

Have one thing that works. Music from when they were young, folding laundry, looking through photographs, a short walk if it's safe. Something familiar and undemanding, saved for that hour.

What makes it worse

Arguing. Correcting. Quizzing. If your father says he needs to get to work, telling him he retired in 2004 doesn't land as information. It lands as an argument he can't win, and the distress is what's left over after the facts are forgotten.

Going along with the feeling instead of the fact isn't lying to him. Asking what he has going on at work, agreeing it sounds important, saying you'll sort it out together after dinner, that usually moves things along in a way correcting him never does.

Television in the evening is worth watching carefully. News, raised voices, fast editing. For somebody already struggling to tell what's in the room from what's on the screen, it adds to the problem.

When it isn't sundowning

Sundowning builds gradually over weeks or months and follows the same daily shape.

A sudden change is different. If somebody becomes confused or agitated far more than usual over a day or two, or the pattern stops fitting the usual hours, it's worth mentioning to their doctor rather than assuming the dementia has moved on. Infections, pain somebody can't describe, dehydration and a recent change to a medication can all look like worse dementia from the outside, and all of them are treatable.

This is the kind of change a caregiver who's in the home regularly tends to notice early, because they know what an ordinary day looks like for that person.

Where paid help fits

Families often think about round-the-clock care or nothing at all, and then decide they can't do either. For sundowning specifically there's a smaller version that works.

A caregiver covering the late afternoon and early evening, which are the hours this actually happens. Lights on, meal made, the evening kept calm, somebody there who isn't already exhausted. The family gets that hour back, and the person with dementia gets consistency at the time of day they most need it.

If the nights have also become difficult, 24 hour home care covers them with caregivers working in shifts so somebody is awake. And if the person doing all of this is a family member who hasn't had a break in months, respite care exists for exactly that, which we've written about in more detail in respite care for family caregivers.

If you're further along than this, the middle stage of Alzheimer's at home covers what changes and what to plan for.

This article is general information for families and is not medical, legal, financial or insurance advice.

How Golden Years helps

Golden Years Home Care provides in-home care across California. That includes companion care, personal care, dementia care and Alzheimer's care at home, plus 24 hour home care when the nights need covering too.

Our caregivers are our own employees, not contractors. They're screened, background checked and trained by us, and they're matched to the person rather than to a slot on a schedule, which matters more with dementia than with anything else we do.

We've been family owned since 1996. Care starts with a free in-home assessment, with no obligation and nothing to sign, whether you need a few evening hours, dementia care, Alzheimer's care at home or 24 hour home care. Licensed as a Home Care Organization, HCO #344700040.