Sundowning

Sundowning

Patient and Carer Information

Admiral Nurse Service

• Author ID:           MO 
• Leaflet Ref:         Med 008 
• Version:              5 
• Leaflet title:         Sundowning 
• Date Produced:   October 2025 
• Expiry Date:        October 2027 

What is Sundowning?

If someone you care for has dementia, their confusion and agitation may get worse in the late afternoon and evening.  In comparison, their symptoms may be less pronounced earlier in the day.  This is called Sundowning and is a symptom of dementia.  It can be a new confusion which only occurs at this time of day, or an increase in confusion that occurs typically between the hours of 4:30pm and 11pm.

The person is most likely to experience Sundowning if they have mid-stage to advanced dementia.

Causes

Fading light seems to be a trigger. The symptoms can get worse as the night goes on and usually get better by morning. The reduced lighting and increased shadows can cause people to misinterpret what they see and become confused and afraid. 

Together with:

• End-of-day exhaustion (both mental and physical).
• An upset in the "internal body clock", causing a mix up between day and night.  Reactions to nonverbal cues of frustration from caregivers who are exhausted from their day.
• Disorientation due to the inability to separate dreams from reality when sleeping. 

It is also more likely to occur if the person is:

• Too tired
• Too hungry
• Depressed
• In pain
• Bored
• Having sleep problems

Symptoms

• Agitation and anxiousness
• Restlessness and irritability
• Confusion and disorientation
• Suspiciousness

They may also:

• Hear things that aren’t there (auditory hallucinations).
• See things that aren’t there (visual hallucinations).

Things you can do

Although you may not be able to stop it completely, you can take steps to help manage this challenging time of day so that the person can sleep better and is less tired during the day.

Try to:

• Keep things calm in the evening.
• Close curtains and or blinds and turn on the lights.
• Care staff and family members should try and not make too much noise.
• Play relaxing music which the person likes.

How to react

• Stay calm
• Remind the person what time of day it is
• Don’t argue 
• Reassure them

If they need to get up and move around, or pace, as long as they are safe don’t try to stop them. Just stay close and keep an eye on them.

If the symptoms persist, then the doctor may be able to prescribe medication.

Further help and advice can be obtained from:

In hospital:

Admiral Nurse (Clinical Nurse Specialist for Dementia) 8612

Hospital Switchboard Bleep 2507

External - telephone 01942 778612

RAID Team 

Greater Manchester Mental Health NHS Foundation Trust

Telephone 01942 822167

Dementia UK:

www.dementiauk.org

0800 888 6678

Mon-Fri 9am-9pm / Weekends 9am-5pm

Alzheimer’s Society

www.alzheimers.org.uk

Telephone 01942 247837

Mon-Fri 9am-5pm / Weekends 10am-4pm

Later Life and Memory Service (LLAMs)

Telephone 01942 764462

Mon-Fri only