For families caring for a loved one with dementia, evenings can bring changes in a dementia patient that are hard to understand. A familiar room may suddenly feel unfamiliar, or your loved one may repeatedly ask to go home even when they’re already there. These moments can leave you unsure how to respond or offer reassurance.
Known as sundowning in dementia, this pattern of increased confusion, restlessness, or agitation often develops toward the end of the day. Each person’s experience is different, but understanding possible triggers and keeping a consistent routine may help you navigate the evening hours. Our Alzheimer’s and dementia care team recognizes that support should reflect each person’s individual needs. This guide explores what sundowning can look like and practical ways to support your loved one.
What Sundowning Looks Like
Sundowning is a pattern of confusion, anxiety, agitation, pacing, or trouble sleeping that begins or gets worse as daylight fades. It is not a separate disease. The Alzheimer’s Association describes symptoms that may continue from dusk through the night.
Early signs may be easy to miss. Your loved one may become restless at dinner, ask to “go home,” shadow you around the house, or become suspicious in a way that was not present that morning. This sundowning behavior may last for a few hours, or it may continue through much of the night.
When having a loved one with dementia, look for a pattern, not one difficult evening. Write down when the change starts and what happened just before it. keeping records can help you identify triggers and give the healthcare provider a clearer picture. Some evenings may start with repeated questions. Others may begin with pacing, pulling at clothes, or checking the front door. These early sundowning dementia symptoms matter because it is often easier to respond before fear or frustration builds.
What Triggers Sundowning?
The exact cause is not known. Sundowning may have more than one trigger, and the mix can change from day to day.
- Being worn out after a busy or confusing day
- Low light, glare, or shadows that are easy to misread
- A body clock that is out of sync
- Too much noise, television, conversation, or activity in the evening
- Hunger, thirst, pain, constipation, or another unmet need
- Picking up on a caregiver’s stress or frustration
Medications may also contribute. Ask your loved one’s doctor or pharmacist to review each medicine and when it is taken, and never stop a medication without their guidance. Triggers can be as small as a dark hallway that suddenly looks unfamiliar or a loud noise that makes a busy room feel more confusing. To pinpoint what triggers sundowning, start with your loved one’s surroundings, track their daily routine, and note what tends to come before difficult moments.
How Common Is Sundowning, and What Stage Does It Start?
There is no formal sundowning diagnosis and no agreed-on dementia stage when it bedementia stage when it begins. A 2025 review in the Journal of Clinical Medicine found that estimates vary widely between studies, with some studies reporting sundowning in more than 60% of people living with dementia.
It can appear at different points and change over time. If a new behavior comes on suddenly, do not assume it is sundowning. A medical problem may be causing the change. The time of day is one clue, but it is not proof. Tell the provider whether the Behavior appears only in the evening, how long it lasts, and whether sleep, appetite, bathroom habits, or walking have changed.
How to Help Someone Who Is Sundowning
There is no single fix for sundowning, but the way you respond can help evenings feel calmer for both of you. The National Institute on Aging recommends staying calm, listening to your loved one’s concerns, offering reassurance, and avoiding arguments. The tips below show simple ways to put these ideas into practice.
Check for simple needs first. Does your loved one need the bathroom, a drink, a snack, a sweater, or help with pain? Then redirect their attention to something familiar, like favorite music, family photos, or a short walk. Use one short sentence at a time. Give the person a moment to respond. If an idea is not helping, let it go and try something quieter. Your goal is comfort and safety, not winning the facts of the moment.
| Try This | Not That |
| “You’re safe. I’m right here.” | “You already asked me that.” |
| Offer water, a snack, or the bathroom. | Ask several questions at once. |
| Lower the TV volume and reduce the number of people nearby. | Argue about what is true. |
| Let the person pace if the path is safe and someone stays nearby. | Block the way or physically restrain the person. |
| Redirect to music, towels, photos, or a short walk. | Force an activity the person is resisting. |
Never restrain someone who is pacing. If anyone is in immediate danger, contact emergency services and tell the dispatcher that the person has dementia.
When to Call the Doctor
A sudden behavior change can come from something treatable, including pain, constipation, infection, or a medication problem. Call the provider if the change happens quickly, aggression is getting worse, you suspect a medicine is involved, or you no longer think the person is safe at home.
Check with the provider before giving any over-the-counter sleep medicine. Many store-bought sleep aids can make confusion worse. Bring your log and medication list to the appointment. Ask when the provider wants an urgent update and what changes should lead to emergency care. If the person has fallen, cannot be redirected from a dangerous situation, or may hurt someone, get immediate help.
Looking After Yourself, Too
Caring for someone with dementia around the clock can be exhausting, so your own well-being matters too. In the Alzheimer’s Association’s 2026 report, 59% of dementia caregivers said they had high or very high emotional stress. More than 80,000 Kentuckians age 65 and older are living with Alzheimer’s.
November is National Family Caregivers Month, but you deserve support all year. The Alzheimer’s Association Kentucky chapter offers a 24/7 Helpline and free caregiver support groups in and around Louisville, including virtual options. Registration is required. Its Louisville office is at One Oxmoor Place on Bullitt Lane. Louisville East Post Acute is not affiliated with the Association.
If you start to feel overwhelmed, lean on family, friends, or care professionals. Try to share caregiving duties before you reach the point of exhaustion. While your loved one is safe, take a moment to eat, drink some water, and breathe slowly. Asking for help or taking a break is not a sign of failure. Looking after yourself is just as important as caring for your loved one.
Support for the Evenings Ahead
Sundowning in dementia can make evenings unpredictable, but you do not have to face them alone. Small steps, like noticing patterns, keeping a steady routine, and responding with patience, can help your loved one feel safer as the day winds down. If evenings are becoming harder to manage at home, the Alzheimer’s and dementia care team at Louisville East Post Acute is here to answer your questions. Contact us or schedule a tour to learn how we support residents and families in Louisville and the surrounding Kentuckiana area.