Sundowning: What It Is and How Live-in Carers Manage It

If you care for someone living with dementia, you may have noticed a distressing pattern: as afternoon turns to evening, they become more confused, restless, anxious or agitated than they were earlier in the day. This is known as sundowning, and it is very common in dementia. It can be exhausting and upsetting, for the person experiencing it and for everyone around them.

The reassuring news is that sundowning can be understood, and there is a great deal that helps to ease it. Here is what it is, why it happens, and how live-in carers manage those difficult hours with skill and patience.

What is sundowning?

Sundowning describes a pattern of increased confusion, agitation, restlessness, anxiety or distress that tends to appear in the late afternoon and into the evening. It takes its name from its timing, as it often begins as the day starts to fade.

It is not a disease in itself, but a cluster of behaviours tied to the time of day. It can show itself in many ways, including confusion or disorientation, restlessness and pacing, anxiety or agitation, irritability or mood changes, becoming suspicious or upset, wanting to leave or to "go home," and difficulty settling or sleeping. For families, it can turn the end of the day, when everyone is already tired, into the hardest part of it.

Why does it happen?

Honestly, the exact cause of sundowning is not fully understood. But several things are thought to contribute, and knowing them helps in managing it:

• Disruption to the body clock, as dementia can affect the internal rhythms that regulate sleep and wakefulness
• Fading light and lengthening shadows, which can cause confusion and misperception as it gets darker
• Mental exhaustion, as the effort of coping with a confusing world all day builds up and tiredness sets in
• Unmet needs, such as hunger, thirst, needing the toilet, or discomfort
• Too much or too little stimulation during the day
• Disrupted routine, or the general busyness and winding-down of the household in the evening
• Picking up on others' tiredness, as an anxious or exhausted atmosphere can be sensed and mirrored

First, rule out other causes

One important note. If your loved one's agitation or confusion is new, sudden, or much worse than their usual pattern, it may not be sundowning at all. It could be a sign of something treatable, such as pain, an infection like a urinary tract infection, constipation, or an issue with medication.

So it is always worth mentioning a marked change to their GP, who can check for an underlying cause. Our guide to UTIs and sudden confusion explains more about how a physical problem can show up as a change in behaviour.

How to ease sundowning

A person-centred approach helps a great deal, and much of it is about calm, routine and comfort:

• Keep a calm, consistent daily routine, as predictability reduces anxiety and confusion.
• Manage the light. Let in plenty of daylight during the day, keep rooms well lit as it gets dark, and close curtains before dusk to reduce the confusing shadows and reflections that can unsettle someone.
• Plan the day thoughtfully, with more active, engaging things earlier on and calmer, quieter evenings. Try to avoid too much daytime napping, which can disrupt night-time sleep.
• Keep evenings peaceful. Reduce noise, busyness and overstimulation as the day winds down, and offer soothing, familiar activities instead.
• Meet physical needs. Make sure your loved one is not hungry, thirsty, uncomfortable, in pain, or in need of the toilet, as any of these can drive agitation.
• Reassure, do not argue. If your loved one is confused or upset, gently reassure and comfort them rather than correcting or challenging them. Validating their feelings and gently redirecting works far better than confrontation.
• Offer comfort. Familiar music, a warm drink, looking through old photographs, or a favourite calming activity can all soothe.
• Watch for triggers, noting what tends to come before an episode, which can help you head it off.

And do look after yourself, because your own calm genuinely helps. Sundowning is draining for carers, and a settled, unhurried manner is one of the most soothing things of all.

How live-in carers manage it

This is an area where the skill and constancy of a live-in carer make a real difference, and it comes down to a few things.

A calm presence through the difficult hours. A live-in carer is there during the late afternoon and evening, providing steady reassurance and company at exactly the time anxiety tends to peak, so your loved one is never alone and frightened.

Knowing your loved one. Because they are a consistent presence, a carer learns your loved one's particular triggers and patterns, and what soothes them, and can prepare for and gently ease the difficult time of day.

Keeping routine and managing the environment. A carer maintains the calm, predictable rhythm that helps, and handles the practical things, the lighting, the peaceful evening, the comfort, that make sundowning less likely to take hold.

A skilled, patient response. Trained in dementia care, a carer responds to agitation with calm, validation and gentle redirection rather than frustration or confrontation. That patient, knowledgeable approach can defuse distress that might otherwise escalate.

Continuity into the night. If sundowning disrupts sleep, the carer is there overnight too, to reassure and help your loved one settle.

A real relief for families

It is worth saying plainly: the evening is very often the hardest, most draining part of the day for family carers, arriving just when their own reserves are lowest. Having a skilled carer take on those hours, calmly and expertly, is an enormous relief.

And there is a deeper benefit. A fresh, calm, professional presence tends to soothe far more effectively than an exhausted, stretched family member possibly can, through no fault of their own. So live-in care often helps not just the family, but the person themselves, to have calmer evenings.

Calmer evenings are possible

Sundowning is one of the more challenging aspects of dementia, but it is common, it is understood, and it can be managed. With the right understanding, a calm environment and consistent routine, and patient, knowledgeable support, those difficult hours can become gentler and more settled, for your loved one and for you.

If you would like to talk through how we support people living with dementia through the day and night, we would be very glad to help. The Alzheimer's Society and Dementia UK also offer excellent advice on sundowning and dementia care.

Book a free care advice call, or give us a ring on 020 3970 9900.

This guide offers general information and is not medical advice. If your loved one's confusion or agitation is new or worsening, please speak to their GP, who can check for any treatable underlying cause.