Quick Overview: Does your loved one become more confused, restless, or anxious as evening approaches? They may be experiencing sundown syndrome, a pattern that can occur in people living with dementia. This guide from JCHC explains what causes sundowning in dementia, common sundowning symptoms, and offers advice for caregivers on how to help someone experiencing sundowning,
Your parent seems comfortable throughout the morning. You have lunch together, talk about familiar things, and perhaps even share a laugh. But as the afternoon winds down, something changes. They become restless or anxious. They may insist they need to “go home” even though they are already there, or seem much more confused than they were just a few hours earlier.
For families caring for someone with Alzheimer’s disease or other forms of dementia, these changes can be difficult to understand and even harder to manage. When they repeatedly occur in the late afternoon or evening, they may be signs of sundown syndrome.
At Jewish Community Housing Corporation (JCHC), we understand how challenging it can be to watch a loved one experience these changes. Having served older adults and their families in New Jersey for nearly 45 years, we also know how much the right information and support can help. That’s why we’ve created this guide to explain what causes sundowning in dementia, common sundowning symptoms, and practical ways to help your loved one feel safer and more comfortable as evening approaches.
What Is Sundowning in Dementia?
Sundowning, also called sundown syndrome, late-day confusion, or sundowner’s syndrome, is not a disease or a separate diagnosis from dementia. It refers to changes in behavior, such as increased confusion, restlessness, anxiety, or agitation, that tend to appear or become more noticeable in the late afternoon and evening.
The National Institute on Aging (NIA) recognizes sundowning as one of the sleep-related challenges that may occur in people living with Alzheimer’s disease.
Individuals with dementia experience sundowning in different ways. It is not known how common sundowning is, partly because there isn’t a universally accepted definition. Researchers have reported widely varying prevalence estimates ranging from roughly 1.6% to 66% of people with dementia, depending on the population, setting, and criteria used.
What we do know is that not every person living with dementia will experience sundowning, and the experience can look very different from one person to another.
Symptoms of Sundowning in Dementia
For one person, sundowning may look like mild restlessness. For another, evenings may bring significant confusion or distress.
Common signs can include:
- Increased confusion or disorientation
- Anxiety, nervousness, or fear
- Irritability or agitation
- Pacing or wandering
- Difficulty settling down
- Calling out or repeatedly asking the same questions
- Difficulty recognizing familiar people or surroundings
- Trouble falling or staying asleep
- Wanting to “go home,” even if they’re already at home
- Becoming more suspicious or upset than usual
You may also notice that these behaviors happen at a fairly predictable time each day. However, if your loved one suddenly develops severe confusion or their behavior changes dramatically from their usual pattern, it’s important to discuss it with a healthcare professional instead of assuming it to be sundown syndrome.
What Causes Sundowning in Dementia?
There is no single confirmed cause of sundown syndrome. Research published in Frontiers in Medicine suggests that there are a few factors that may trigger or worsen sundowning symptoms, including:
- Circadian rhythm disruption: Dementia can affect the body’s circadian rhythm. This helps the body recognize when it’s time to be awake or asleep and triggers the production of the sleep-related hormone melatonin. Disrupting this rhythm may contribute to increased confusion or restlessness later in the day.
- Fatigue: By late afternoon, a person with dementia may be physically and mentally tired. This can make it harder to process their surroundings, communicate their needs, or cope with confusion.
- Fading light and shadows: As daylight fades, shadows and reflections become more noticeable. A person with dementia may misinterpret what they see, making otherwise familiar surroundings seem confusing or frightening.
- Overstimulation: A day filled with appointments, visitors, conversations, television, or other activity can become overwhelming. By evening, this accumulated stimulation may contribute to restlessness or agitation.
- Changes in routine: People living with dementia may rely on familiar routines to understand what is happening around them. Changes in their schedule, caregivers, or surroundings can sometimes increase uncertainty and confusion.
- Unmet physical needs: Hunger, thirst, pain, discomfort, or needing to use the bathroom may be difficult for someone with dementia to communicate. Instead, these needs may appear as restlessness, irritability, or other changes in behavior.
How to Help Someone With Sundowning
There isn’t a universal strategy to help someone with dementia experiencing sundowning. However, by noticing their behavior patterns, you can gradually learn strategies that can help make your loved one’s evenings easier.
Here are several approaches families can try:
1. Keep Their Days Predictable
Familiar routines can help make transitions smoother and easier for your loved one to process, according to the National Council of Certified Dementia Practitioners (NCCDP).
The NCCDP also suggests maintaining a predictable schedule of waking up, meals, activities, and bedtime at approximately the same times each day. If bathing tends to be stressful in the evening, for example, consider moving it to the morning.
If Dad usually becomes restless around 5 p.m., avoid scheduling appointments or unfamiliar outings late in the afternoon when possible. A familiar routine—an early dinner followed by music he enjoys—may make that transition easier.
2. Make Good Use of Daylight and Activity
Encourage appropriate daytime movement and exposure to daylight when possible. A short walk, time outdoors, or another enjoyable activity earlier in the day may support a healthier daily routine.
The NCCDP and the National Institute on Aging (NIA) recommend daily exercise for people with Alzheimer’s who are experiencing sleep difficulties.
3. Watch for Patterns and Triggers
Take note of what happens before each episode to help identify potential triggers.
Ask yourself: When did the confusion begin? What happened during the day? Was your loved one tired, hungry, or overstimulated?
You may begin to notice patterns that aren’t obvious at the moment. For instance, if you find that crowded family dinners consistently make Mom anxious, a quieter meal with fewer people may feel more comfortable.
4. Create a Calmer Evening Environment
As evening approaches, try gradually shifting the environment rather than suddenly moving from a busy day to bedtime.
Here are some ways to create a comforting home setting from the NIA. :
- Reduce unnecessary noise and clutter.
- Play soothing, familiar music.
- Keep well-loved objects and photos around the home
- Let in natural light during the day. Close curtains or blinds if reflections become confusing.
- Offer a familiar activity like watching a show on TV.
5. Respond to the Feeling, Not Just the Facts
If Mom says, “I have to go home. My parents are waiting for me,” correcting her may only increase her distress.
Instead, focus first on the emotion underneath the statement. She may be frightened, confused, or looking for somewhere that feels safe.
A calmer response might be: “You miss home. Tell me about it,” followed by gentle reassurance or a familiar activity.
When someone is already confused, the goal is not to correct them. . Sometimes, helping them feel safe is more important in that moment.
6. Talk With Their Healthcare Provider
It isn’t always easy to know whether a change is part of sundown syndrome or something else. If symptoms are new, worsening, affecting sleep, or creating safety concerns, talk with your loved one’s healthcare provider. They can check for possible causes, such as pain, illness, or medication side effects, and recommend appropriate next steps.
Avoid starting sleep medications or supplements without medical guidance, as some may create additional risks for older adults.
Caring for Someone With Sundowning Means Caring for Yourself, Too
Caring for someone with sundown syndrome can be exhausting, especially when difficult evenings begin affecting your own sleep and well-being. You may even feel guilty about needing a break or asking someone else to step in. But you don’t have to manage everything on your own.
The Cleveland Clinic reports that more than 60% of caregivers experience symptoms of burnout. Studies show that nearly half of caregivers may be experiencing depression, anxiety, or other mental health issues.
Taking breaks, getting enough rest, and accepting help from family or friends are important parts of caregiving, too. You can also turn to caregiver support groups, respite services, or professional caregivers when you need additional support.
In addition to offering long-term memory care at our Lester Senior Living residence in Whippany, NJ, JCHC offers flexible respite care and short-term stay options. If you’re feeling overwhelmed or in need of more support, our respite care program provides the same high level of care, amenities, and 24/7 personalized support as our full-time residents.
For more information about respite care at JCHC, contact our team today.
Remember that asking for help doesn’t mean you’re letting your loved one down. Sometimes, getting the right support can help you continue caring for them with greater patience, energy, and compassion.
When Might Memory Care Help?
If your loved one is experiencing sundowning occasionally, it does not necessarily mean your loved one needs memory care. But as dementia progresses, their needs may become more difficult to manage safely at home, especially when there is frequent wandering, nighttime wakefulness, increasing confusion, or a need for around-the-clock supervision.
Often, families don’t make this decision because of one incident. According to a U.S. study of 2,200 dementia caregivers published in Gerontologist, common reasons for transitioning a loved one to a residential care setting may include needing more skilled care (65%), concerns about the caregiver’s own health (49%), and dementia-related behaviors (46%).
If you are reaching that point, it doesn’t mean you haven’t done enough. Memory care can provide the additional structure, supervision, and specialized support your loved one now needs while allowing you to spend less time managing every aspect of their care and more time simply being their spouse, adult child, relative, or friend.
Memory Care Support for Your Loved One at Lester Senior Living
Caring for someone with memory loss can bring difficult days, sleepless nights, and decisions you never expected to make. At Jewish Community Housing Corporation (JCHC), we understand how overwhelming this journey can sometimes feel, and we want families to know they don’t have to navigate it alone.
At Lester Senior Living in Whippany, New Jersey, our memory care program provides personalized support for older adults living with Alzheimer’s disease, dementia, and other forms of cognitive decline. With 24/7 care and supervision, specialized caregivers, structured routines, therapeutic activities, and opportunities for meaningful connection, we work to create an environment where your loved one can feel safe, comfortable, and supported.
For families, that support can also bring greater peace of mind, knowing someone is there for your loved one throughout the day and during evening and nighttime hours when sundowning may become more challenging.
Our team has been recognized by Suburban Essex as a Gold Winner for Best Senior Care in both 2024 and 2025. But the feedback that means the most to us comes directly from the people who call our communities home. Myra, one of our senior living residents, shared:
“The help here is unbelievable. They’re friendly, they’re kind. They answer questions immediately without any attitude… I’ve been calling people and telling them about this. I’m really very happy here.”
If you’re wondering whether memory care might be the right next step, our team can help you navigate the transition. Contact us or schedule a tour of Lester Senior Living to ask questions, talk through your concerns, and learn what support could look like for your loved one and your family.
Frequently Asked Questions
Q: What causes sundowning in dementia?
While research has not confirmed a single rationale for what causes sundowning in dementia, there are a number of factors that may trigger or worsen sundowning symptoms, such as:
- Disrupting the body’s circadian rhythm and production of melatonin, a sleep-related hormone
- Fatigue from daily activities
- Misinterpreting fading light and shadows, making familiar surroundings seem frightening
- Overstimulation from conversations, appointments, visitors, and watching TV during the day
- Changes in routine causing uncertainty or confusion
- Unmet needs, such as hunger, thirst, or needing to use the bathroom
Q: How can I help someone with sundowning?
A: When dealing with episodes of sundowning in dementia, try to remain calm, reduce noise and stimulation, make the environment comfortable and well lit, offer reassurance, and redirect your loved one toward a familiar activity. Rather than arguing about something they believe to be true, acknowledge the emotion they are expressing and help them feel safe.
Q: Does sundowning happen every night?
A. Not necessarily. Sundowning can vary in frequency and intensity. Keeping track of when symptoms occur and what happened earlier in the day may help families identify patterns or triggers.
Q: Can memory care help with sundowning in dementia?
A: Yes, memory care can provide a structured environment, trained caregivers, supervision, predictable routines, and support designed specifically for people living with cognitive decline. At JCHC’s Lester Senior Living residence in Whippany, NJ, residents in memory care receive individualized support and 24/7 care and supervision.
Q: Does JCHC offer short-term respite care options?
A: Yes! At our Lester Senior Living residence in Whippany, NJ, we offer short-term respite care. Families choose our respite care option for many different reasons. It’s helpful for seniors recuperating from an injury or hospital stay. It can help caregivers cover emergency gaps in care and provide a well-deserved break so they can take time to care for themselves. Some families choose a respite care stay to determine if senior living is a good fit for their loved one.
Whatever the reason, our respite care guests have access to all of the same services as our full-time residents, including 24/7 care and support, access to amenities, personal engagement, kosher meals, and engaging activities.
Q: Is JCHC open to seniors of all faiths?
A: Yes, JCHC is open to seniors of all faiths and backgrounds. Many of our residents are not Jewish, and all older adults are welcome in our community.