How to Handle Sundowning in Dementia Patients

This page may contain affiliate links. If you make a purchase through any of these links I will make a small commission. As an Amazon Associate I earn from qualifying purchases.

How to Handle Sundowning in Dementia Patients

Sundowning is a common phenomenon in dementia patients, characterized by increased confusion, agitation, and restlessness in the late afternoon and evening.

This behavior can be challenging for caregivers, but understanding its causes and implementing effective strategies can help manage sundowning symptoms.

This article provides insights into sundowning and offers practical tips for handling it.

Understanding Sundowning

Sundowning, also known as late-day confusion, affects many individuals with dementia. It typically occurs during the late afternoon or early evening and can last into the night. While the exact cause is not known, several factors are believed to contribute to sundowning.

Possible Causes

Internal Factors

  • Circadian Rhythm Disruption: Dementia can disrupt the body’s internal clock, leading to confusion and restlessness as the day transitions to night.
  • Fatigue: As the day progresses, fatigue can exacerbate symptoms of confusion and agitation.
  • Hunger or Thirst: Unmet physical needs, such as hunger or thirst, can contribute to discomfort and agitation.

External Factors

  • Environmental Changes: Changes in lighting, noise, and activity levels during the evening can trigger sundowning.
  • Overstimulation: A busy or overstimulating environment throughout the day can lead to increased agitation in the evening.
  • Reduced Vision: Lower light levels in the evening can cause visual misperceptions and increase confusion.

Recognizing Sundowning Symptoms

Behavioral Symptoms

  • Increased confusion and disorientation.
  • Agitation and restlessness.
  • Pacing or wandering.
  • Verbal or physical outbursts.

Emotional Symptoms

  • Anxiety and fear.
  • Irritability and frustration.
  • Depression or sadness.

Strategies for Managing Sundowning

Create a Calm Environment

Reduce Noise and Stimulation

  • Minimize loud noises, clutter, and distractions in the late afternoon and evening.
  • Create a quiet and calming atmosphere, using soft music or white noise if helpful.

Adjust Lighting

  • Ensure that the home is well-lit during the evening to reduce shadows and improve visibility.
  • Use nightlights to provide gentle illumination and reduce the risk of falls.

Maintain a Consistent Routine

Establish a Daily Routine

  • Stick to a consistent daily schedule to provide structure and predictability.
  • Include regular times for meals, activities, and rest to create a sense of routine.

Plan Calming Activities

  • Engage in calming activities in the late afternoon and evening, such as reading, listening to soothing music, or gentle stretching exercises.
  • Avoid stimulating activities, such as watching action-packed TV shows or engaging in intense conversations, during this time.

Address Physical Needs

Monitor Hunger and Thirst

  • Ensure that the person with dementia is well-hydrated and has regular meals and snacks throughout the day.
  • Offer a light, nutritious snack in the late afternoon to prevent hunger-related agitation.

Manage Fatigue

  • Encourage short naps or rest periods during the day to prevent overtiredness.
  • Avoid long naps or sleeping too late in the day, as this can interfere with nighttime sleep.

Use Distraction Techniques

Redirect Attention

  • Gently redirect the person’s attention to a different activity or topic if they become agitated.
  • Offer engaging and enjoyable activities, such as looking at photo albums, doing simple crafts, or playing with a favorite pet.

Provide Comfort and Reassurance

  • Offer reassurance and comfort, using a calm and soothing tone of voice.
  • Use physical touch, such as holding hands or giving a gentle hug, if it is comforting to the person.

Promote Better Sleep

Create a Relaxing Bedtime Routine

  • Establish a relaxing bedtime routine that includes calming activities, such as taking a warm bath, listening to soft music, or practicing relaxation techniques.
  • Keep the bedtime routine consistent to signal to the body that it is time to wind down.

Optimize the Sleep Environment

  • Ensure that the bedroom is comfortable, with a supportive mattress and pillows.
  • Keep the room cool, dark, and quiet to promote restful sleep.

When to Seek Professional Help

If sundowning symptoms become severe or unmanageable, it may be necessary to seek professional help. A healthcare provider can assess the situation and recommend additional strategies or treatments, such as:

  • Medication Adjustments: In some cases, adjusting medications or prescribing new ones can help manage symptoms.
  • Therapeutic Interventions: Occupational or behavioral therapy can provide techniques to manage agitation and confusion.
  • Specialized Care: A dementia care specialist can offer personalized advice and support tailored to the individual’s needs.


Sundowning can be a challenging aspect of dementia care, but with understanding and proactive management, it is possible to reduce its impact.

By creating a calm environment, maintaining a consistent routine, addressing physical needs, and using effective distraction techniques, caregivers can help their loved ones manage sundowning symptoms and improve their overall quality of life.

Remember, seeking professional help is always an option if additional support is needed.

Leave a Comment

Your email address will not be published. Required fields are marked *

Scroll to Top