This page is part of PrimeCarers' guide to dementia care. It answers one question: what sundowning is, and what to do about it.
The short answer
- Confusion and agitation that build as daylight fadesIt usually starts in the late afternoon or early evening and can continue into the night. It is a recognised pattern in dementia, not a new illness.
- Watch for more confusion, restlessness and wanting to "go home"Pacing, suspicion, low mood and disturbed sleep are all part of the same pattern.
- Routine, daylight and a calm evening help mostA predictable day, time outside, and lights on before dusk reduce how often and how badly it happens.
- It is the illness, not a reflection of how they feel about youLooking after yourself, and reaching out for support, makes it easier to get through the harder evenings.
Checked against Dementia UK and the Alzheimer's Society, September 2026.
What it is
Confusion and agitation that build as the day fades
Sundowning, sometimes called sundowner's syndrome, is the name given to a pattern of worsening confusion, agitation and restlessness that some people with dementia experience in the late afternoon and evening. It can carry on into the night for some people, which is where the disturbed sleep that often comes with it starts.
According to Dementia UK, sundowning affects around one in five people with dementia overall, and a much larger proportion of people with dementia living in care homes. It tends to be most common in the middle and later stages of dementia, though it can appear earlier or not at all; the seven stages of dementia has more on how symptoms usually build over time.
It does not look the same for every family. Some people show it every evening without fail, others only when the day has been unusually busy or tiring, and a few people with dementia never show the pattern at all. The shape of it can also change from one week to the next, so what helped last month is worth trying again even if it did not seem to work the week before.
The usual order symptoms follow across a day
Morning
Usually the calmest part of the day
Often the best time for a bath, an appointment or anything that needs concentration.
Afternoon
Tiredness starts to build
A short rest or a quiet activity now can make the next few hours easier.
Late afternoon
The time sundowning most often starts
Confusion, restlessness or asking to "go home" tend to begin as the light fades.
Evening
Usually where symptoms are strongest
Agitation, suspicion or, less often, hallucinations are most likely at this point in the day.
Night
Eases for most people, but sleep is often disturbed
For some people the restlessness carries on through part of the night as well.
This is the order families and staff most often describe, not a measured or timed pattern. It does not look the same for everyone.
The exact cause is not fully understood, but a few things are believed to play a part: a disrupted internal body clock, which is common in dementia and can leave someone more alert at night and more tired during the day; tiredness building up over the day; less natural light and longer shadows as dusk approaches, which can make familiar rooms look unfamiliar; and a full or overstimulating day catching up all at once. What looks like sundowning can also be your relative trying to communicate a need they can no longer put into words: needing the toilet, feeling hungry or being in pain. It is worth checking the simple things first. None of this means anything has gone wrong, and it is not something you or your relative are doing.
Signs to watch for
What sundowning usually looks like
Every person with dementia is different, so not every sign below will show up, and some people show only one or two. Most families first notice a pattern rather than a single event: the same time of day, more or less every day.
Signs that tend to appear together
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What you might see
Keeping a short note of what happens, when it starts and what came before it (a busy afternoon, a missed drink, a visitor who has just left) can help you and a GP spot what is triggering it for your relative in particular. A week or two of notes, even a few words a day, is usually enough to see a pattern, and it is worth taking to a GP appointment if the evenings are becoming hard to manage, or if any of the signs above are new.
What helps
What tends to make the evenings calmer
There is no single fix for sundowning, and what works varies from person to person. Most families find a combination of these, kept up every day, does more than any one change on its own, and that it takes a couple of weeks of trying before a pattern of improvement is clear.
- 1
A steady daily routine
All dayThe same times for waking, meals and activity, with time outside or by a window earlier in the day. Daylight during the day and a nap kept short, or dropped altogether, both help the body clock settle into a more normal rhythm. - 2
Lights on before dusk
Late afternoonTurning lamps on before the room starts to darken removes the shadows that can look unfamiliar or frightening, closing the curtains at the same time each day, and is one of the simplest changes a family can make. - 3
A quieter evening
EveningLess noise and activity in the hour or two before the pattern usually starts: the television lower, fewer visitors, one calm task rather than several things happening at once. - 4
Distraction and reassurance rather than argument
When it startsA familiar activity, a photograph or a favourite piece of music can settle someone more than trying to correct them. Reassurance about where they are and who is with them usually works better than facts. - 5
A dementia clock, if the time of day is part of the confusion
OngoingA clock that shows the day, date and whether it is morning, afternoon or night in plain words can reduce some of the "what time is it" and "why is it dark" questions.
Looking after yourself too
Sundowning is exhausting to live with, and that is worth saying
Evenings that repeat the same distress, night after night, wear a family down. None of it reflects how your relative feels about you, and looking after yourself is part of looking after them well.
It is the dementia, not the relationship
A dementia cafe can help both of you
Support lines exist for exactly this
If it becomes too hard to manage at home
If you go looking for support, what are dementia cafes explains what to expect from one, and the Alzheimer's Society's Dementia Support Line or Dementia UK's Admiral Nurse helpline are worth calling even for a single bad week rather than only once things feel unmanageable. Both are staffed by people who hear about evenings like this every day, and neither needs a diagnosis or a crisis before you call. If the evenings, on top of everything else, have you asking whether home is still the right place, at what point should someone with dementia go into care sets out how to think it through.
Questions
Questions families ask about sundowning
Sundowning is the name given to a pattern of worsening confusion, agitation and restlessness that some people with dementia experience in the late afternoon and evening, as daylight fades. It is a recognised part of dementia rather than a separate illness, and for some people it continues into the night.
The exact cause is not fully understood. A disrupted internal body clock, tiredness building up through the day, dimming light and longer shadows, and an overstimulating day are all thought to play a part. It is not caused by anything a family does.
No. Dementia UK estimates it affects around one in five people with dementia overall, and a larger proportion of people with dementia in care homes, where routines and lighting are harder to control for one person at a time. It is most common in the middle and later stages, though it can appear earlier for some people and not at all for others. The seven stages of dementia explains how symptoms typically build through the illness.
It can ease with a steady routine, more daylight during the day and a calmer evening, and some people have periods where it settles for weeks at a time. It is not usually something that is cured, but most families find it becomes more manageable once they know the pattern and plan around it.
Sundowning follows a daily pattern that builds gradually over weeks. A sudden change over a day or two, especially with a temperature or new confusion at any time of day, is more often an infection or a reaction to medication and needs a same-day GP call or 111. Signs that dementia is getting worse covers how to tell the two apart.
Yes. A carer who knows your relative and their usual routine can be booked for the hours sundowning tends to happen, keep the evening calm and familiar, and settle your relative for the night, which also gives a family carer an evening off. Every carer found through PrimeCarers has an online interview and an identity check, a right to work check and an enhanced DBS check kept on the Update Service before they appear, and carers are self-employed rather than employed by PrimeCarers.