Caregiver Guide

Sundowning: calming late-day agitation in dementia

If your hardest hours are between four and eight in the evening, you are not imagining it. Sundowning is real, common, and largely preventable with a rhythm rather than a reaction.

What may be happening

As daylight fades, the internal body clock, accumulated fatigue, and lower blood sugar all converge. A brain that has been compensating all day runs out of reserve, and restlessness, pacing, or wanting to “go home” appears.

Possible causes

  • Fatigue from a full day of effortful thinking
  • Fading light, shadows, and glare that distort what the eye sees
  • Hunger or dehydration late in the day
  • Too much afternoon caffeine or an over-long nap
  • Household activity spiking at dinnertime — noise, TV, visitors
  • The caregiver's own end-of-day exhaustion, which the person senses

What to do right now

  1. 1Build the calm before the storm: start winding the house down by 3:30 p.m.
  2. 2Turn lights on before dusk to erase shadows, and close curtains at sunset.
  3. 3Offer a protein snack and water mid-afternoon.
  4. 4Move the biggest activity of the day — bathing, appointments — to the morning.
  5. 5Give a simple purposeful task at 4 p.m.: folding towels, sorting cards, watering plants.
  6. 6Keep evenings low-stimulation: soft music instead of television news.

What to say

  • “Let's sit down together. It's been a long day.”
  • “I could use your help folding these.”
  • “We'll go in the morning — it's dark out now. Let's have tea first.”
  • “You're safe here with me.”

What not to say

  • Reasoning with the clock: “It's nine at night, there's nowhere to go.”
  • Turning on bright overhead lights suddenly or blaring the TV to distract.
  • Starting demanding tasks after 4 p.m.
  • Blocking the door physically — walk with them instead.

Medical warning signs

  • Agitation that is new, sudden, or dramatically worse than baseline — screen for infection, pain, or medication changes
  • Night wandering that creates a real safety risk at doors or stairs
  • Signs of dehydration or poor intake at dinner

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Ask Bella™ provides caregiver education and coaching, not medical advice, diagnosis, or treatment. In an emergency, call your local emergency number.