What is sundowning?

Sundowning is a pattern of increased confusion, restlessness, anxiety, or agitation that often emerges in the late afternoon and evening in people with dementia. It is not a deliberate behaviour and it is not anyone's fault — it appears to be linked to changes in the body's internal clock, fading daylight, and accumulated fatigue from a day of working harder to make sense of the world.

Why does it happen?

Several factors contribute:

Circadian rhythm disruption — dementia can blur the brain's day/night cycle.
Fading light — shadows, dim rooms, and reflections can become confusing or frightening.
End-of-day tiredness — people with dementia work harder to follow conversations and recognise faces all day. By evening, the reserve runs out.
Hunger, thirst, pain, or needing the toilet — often expressed as restlessness when language fails.
Caregiver stress carrying over — a calm caregiver in the morning is often a tired, distracted caregiver by 5pm. People with dementia are very sensitive to that.

What helps in the moment

When sundowning behaviour escalates — pacing, accusing, refusing, weeping — your first instinct may be to reason or correct ("Pa, I'm your son. I didn't take your wallet."). This almost always makes it worse.

A calmer toolkit:

Validate the feeling, not the fact. "That sounds upsetting. Tell me what happened." You are not agreeing they were robbed — you are agreeing they feel unsafe. That is true, and worth acknowledging.
Redirect gently. "Let's go check the door together" or "Let me put the kettle on first."
Lower the stimulation. Turn off the TV. Draw the curtains before dusk arrives (so the transition isn't visible). Lower your voice.
Offer a simple comfort. A warm drink. A familiar song. A favourite blanket. A photo of a known face.
Don't argue, don't quiz. Avoid "Don't you remember?" — it is humiliating and triggering. Avoid open questions ("What do you want for dinner?") in favour of binary ones ("Soup, or porridge?").

What helps over time

Anchor the day with routine — same wake time, same meal times, same wind-down time.
Daylight in the morning — natural light early in the day helps regulate the body clock.
Reduce caffeine and sugar in the afternoon and evening.
Plan demanding tasks for mornings — bathing, medical appointments, errands. Afternoons are for rest and gentle activity.
Get the person engaged earlier in the day — a structured activities programme builds positive engagement into the early-to-midday hours, leaving energy reserves for the harder evening transition. Caregivers often report that even one morning session a week visibly reduces afternoon agitation.

When to seek help

If sundowning is severe, sudden, or paired with new physical symptoms (a fever, sudden incontinence, new pain), call your GP or polyclinic — sometimes a UTI or another physical cause is making things much worse.

You are not failing

Sundowning is one of the hardest parts of caring for someone with dementia, precisely because it tends to peak at the end of an already-long day. If you've snapped, if you've cried, if you've shut yourself in the bathroom for five minutes — that is not failure. That is being human in an extraordinarily hard situation. Be as gentle with yourself as you are trying to be with them.