What is sundowning? Causes, symptoms, and care tips for seniors with dementia

When someone you love is living with dementia, daily life can feel unpredictable — especially as evening approaches. Many families notice their loved one becoming more confused, agitated, or unsettled at the end of the day. This experience is known as sundowning, and it’s a common part of the dementia journey.

Sundowning is a pattern that often reflects the unique rhythms and needs of each individual. This cluster of behaviors (also called sundown syndrome) is a frequent aspect of memory loss, and it’s one that compassionate care communities like Cogir Senior Living know how to address with skill and understanding.

At Cogir Senior Living, memory care is about helping residents and their families find comfort, connection, and confidence. With supportive routines and a caring team of experts, our communities are designed to ease these transitions so your loved one feels secure at every hour. For a more detailed overview of our specialized programs, learn what memory care is and how it helps seniors with dementia.

So, how can you recognize sundowning in your loved one? How should you manage it, and how do you know when it’s time for memory care support?

Here’s what you should know.

What is sundowning?

When the sun starts to set, patterns of confusion and restlessness can sometimes emerge in someone with dementia. Symptoms ranging from irritability to agitation often peak late in the day, especially for those diagnosed with Alzheimer’s, vascular dementia, or related conditions.

Sundowning isn’t the same for every person, but symptoms tend to follow a recognizable rhythm:

• Increased confusion, anxiety, or agitation in the late afternoon or evening
• Trouble sleeping, or increased pacing
• Heightened emotional responses

Sundown syndrome in elderly individuals is most recognizable between 4:30 pm and 11:00 pm, with symptoms worsening until bedtime. The syndrome is not a disease itself, but rather a cluster of symptoms and behaviors linked to the progression of dementia, disrupted circadian rhythms, and environmental factors.

Quick facts about sundowning

• What is sundowning? Sundowning is a late-day increase in confusion, agitation, and mood changes affecting people with dementia.
• What triggers sundowning? Fatigue, low light, unfamiliar environments, medication changes, and overstimulation can all trigger sundowning.
• What are signs of sundowning? Common signs include restlessness, confusion, aggression, wandering, hallucinations, repetitive questions, shadowing caregivers, and difficulty sleeping.
• When should I seek help? If behaviors put someone’s safety at risk or significantly disrupt daily life, professional support is key.

For more information specifically regarding sleep issues connected to sundowning, we suggest consulting the Alzheimer’s Association’s guide on sleep issues and sundowning.

What triggers sundowning?

What causes sundowner syndrome can look a bit different for every person. Medical experts link sundowning to changes in the brain’s ability to regulate daily cycles (i.e., circadian rhythms), environmental stressors, and sometimes medications. Healthline’s overview of sundowning behavior notes that not all people with dementia experience sundowning.

But for those who do experience it, sundowning triggers can be sudden and intense. Triggers typically include a combination of factors:

• Dementia’s effects on brain chemistry and function
• Unmet needs like hunger, thirst, or pain
• Certain medications’ side effects or interactions
• Changes in lighting and increased shadows
• Changes in daily routines or unfamiliar surroundings
• Overstimulation or excess activity during the day
• Sleep deprivation and nighttime wakefulness
• Emotional stress, anxiety, or depression

If you’re wondering about what triggers sundowning in your loved one, look carefully for timing clues: does it happen after certain routines, changes, or emotional upsets? 

Keeping a journal of changes and patterns for a period of time (and reviewing your findings with your doctor) can help. Pinpointing possible sundowning triggers is the first step to managing these symptoms with better understanding and compassion.

Important note: if your loved one develops new or intense symptoms, it’s important to rule out acute medical issues (like infection, pain, or constipation) because these can mimic or worsen sundowning.

For further insight, the Cleveland Clinic provides a more exhaustive overview of causes, symptoms and treatment of sundowning. 

Symptoms & behaviors to watch for

Families often ask about the range of sundowning behavior and how it evolves as dementia progresses. Key signs include:

• Agitation, restlessness, or pacing
• Confusion, especially about place or time
• Mood changes, from anxiety to anger
• Repetitive questioning and difficulty settling
• Trouble sleeping and frequent nighttime waking

Restlessness may occur at various points in the disease; sudden changes (such as new hallucinations) warrant medical evaluation to rule out delirium or other causes.

Sometimes, sundowning and delirium can overlap, with symptoms like hallucinations or paranoia suddenly appearing alongside the typical restlessness present in dementia. Be aware that restlessness often signals middle-stage progression of dementia and may worsen as your loved one’s condition advances.

The National Institute on Aging offers practical caregiving strategies to cope with the patterns of agitation, aggression and sundowning that come with Alzheimer’s disease.

Effective care tips for families managing sundowning

How can your family manage sundowning? Every family is different, but in most cases, the answer is rooted in empathy and routine. Here’s what often helps:

• Create calming, well-lit spaces to signal “daytime” even after the sun sets
• Stick to structured daily routines to build confidence and predictability
• Offer gentle therapeutic activities, such as music, exercise, or aromatherapy

It’s important to draw on your loved one’s preferences and personality to find the activities that soothe them. Cogir’s Connections Program, for example, uses deeply personalized care plans that include favorite activities and tailored interventions. We find that music programs in particular can work wonders for many seniors with dementia.

Treatment plans should prioritize non-drug strategies. If medications are considered (for example, melatonin), discuss the risks and benefits with a clinician. Evidence is mixed and some sleep or behavior medicines can increase confusion or falls; antipsychotics carry an FDA boxed warning concerning dementia.

When to seek Memory Care support

How do you know it’s time to seek professional support? If safety becomes a concern or if the caregiver is facing exhaustion, it may be time to consider a professional memory care solution.

Advanced signs to watch for include:

• Increased wandering or aggression
• Nighttime disturbances disrupting sleep for everyone at home
• Family caregivers feeling deeply overwhelmed
• Difficulty handling sundowning behaviors alone

For more guidance, learn more about memory care at Cogir Senior Living and how to recognize the signs that it’s time for memory care.

Conclusion

Sundowning is one of the most common and challenging behaviors in dementia care, but it can be managed gracefully with knowledgeable, compassionate support.

With thoughtful intervention and a caring environment, sundowning symptoms can often be reduced and each day can end with confidence and comfort. Experienced care teams like Cogir’s can help you navigate the complexities and transitions ahead, with dignity always at the center.

Ready to take the next step and find a memory care solution? Ask these essential questions as you explore memory care communities.

And remember: caregivers deserve support, too. Explore some essential self-care strategies for dementia caregivers to help replenish yourself in this process. Learn more about memory care at Cogir Senior Living, or contact us today to schedule a tour and see how our programming can support your loved one’s well-being.