Why Does Dementia Get Worse In The Evening? Understanding Sundowning
As dementia progresses, many families will start noticing that their loved one’s symptoms seem to become more difficult later in the day. If they have been relatively settled all morning and become confused, restless or upset as evening approaches, it can lead to more stress and confusion.
This change is known as sundowning or sundown syndrome. It is not a type of dementia, but a pattern of symptoms that can affect people living with Alzheimer’s disease and other forms of dementia.
Understanding why it happens can make it easier to respond calmly and spot practical changes that may reduce distress.
Why Does Dementia Get Worse In The Evening?
Dementia doesn’t always get worse in the evening, but many will experience a temporary increase in confusion and behavioural symptoms as the day goes on. This is known as sundowning. Researchers believe it’s caused by a combination of changes in the brain, mental and physical tiredness, disrupted body clocks, low light levels and environmental factors. Although sundowning cannot always be prevented, consistent routines, good lighting and reducing evening stress can often help.
More About Sundowning
The term sundowning describes a pattern in which dementia symptoms become more noticeable during the late afternoon, evening or overnight.
Sundowning syndrome can affect people with dementia in different ways, with some becoming anxious, while others appear confused or unusually active after being settled earlier in the day. The severity varies from day to day. For example, your loved one might not experience problems for several evenings before having a particularly difficult one.
Common signs include:
- Increased confusion
- Pacing or wandering
- Irritability or agitation
- Repeated questions
- Suspicion or paranoia
- Difficulty recognising familiar people or places
- Calling out or shouting
- Trouble settling to sleep
| Possible cause | How it can affect someone with dementia |
|---|---|
| Mental fatigue | Concentrating and making sense of the world becomes harder after a full day. |
| Changes in the body clock | Dementia can disrupt the brain’s natural sleep-wake cycle, making evenings more confusing. |
| Lower light levels | Shadows and reduced visibility can make it difficult to recognise people, rooms and objects. |
| Hunger or dehydration | Physical discomfort may increase frustration or restlessness. |
| Overstimulation | A busy day with visitors, appointments or noise can become overwhelming by evening. |
| Pain or illness | Someone may struggle to explain they are uncomfortable, so distress appears through their behaviour instead. |
Is Sundowning A Sign That Dementia Is Progressing?
Sundowning is common as dementia advances, but having a difficult evening does not automatically mean the condition has suddenly worsened.
If behaviour changes suddenly or becomes much more severe than usual, you should speak to a healthcare professional. A treatable medical problem may be contributing to the change.
Symptoms can become more noticeable because of temporary factors such as:
- Poor sleep the night before
- A urinary tract infection (UTI)
- Constipation
- Changes to medication
- An unusually busy day
- Missing meals or fluids
Practical Ways To Reduce Sundowning
Small adjustments often help dementia in the evening:
Keep the daily routine predictable
People with dementia usually cope better when meals, dementia-friendly activities and bedtime happen at similar times each day. That’s because familiar routines reduce uncertainty and make the day feel more manageable.
Avoid exhausting afternoons
If several appointments, visitors or outings happen on the same day, your loved one can become fatigued more quickly. So, spacing activities across the week may help reduce evening distress.
Create a calmer evening environment
Many people benefit from reducing stimulation later in the day.
This might include:
- Lowering television volume
- Switching off background noise
- Gentle music if they enjoy it
- Familiar activities such as looking through photographs or folding towels
- Keeping conversations calm and unhurried
Watch for physical needs
Before assuming behaviour is caused by dementia, check for practical issues.
A quick checklist includes:
- Have they eaten recently?
- Have they had enough to drink?
- Are they too hot or too cold?
- Do they seem to be in pain?
- Have they been to the toilet?
Improve lighting before it gets dark
Turn the lights on before it gets dark so that rooms stay consistently bright. Closing curtains before reflections appear in windows can also reduce confusion.
Supporting Your Loved One Through Difficult Evenings
Sundowning can be exhausting for both the person living with dementia and those caring for them. Not only is it physically taxing, but it’s often upsetting to watch someone you love become distressed after what seemed like a good day.
While there isn’t a single solution, this article helps you understand the reasons behind evening changes with dementia, making it easier to respond with patience and confidence.
To recap, small changes to routines, lighting and the home environment can reduce triggers and help evenings feel calmer. If symptoms start happening more often, become severe or change suddenly, seeking advice from a healthcare professional or looking at reputable dementia care homes is always the safest next step.
Ready to explore...
