Lifestyle

Restlessness or Confusion That Starts as Daylight Fades Can Be Sundowning. Signs Family Caregivers Often Notice First

By Erica Coleman · November 8, 2026

The morning goes fine. Lunch is calm. Then, somewhere around late afternoon, a parent or spouse living with dementia starts to change. They pace. They seem anxious or confused in a way they were not at breakfast.

Families who see this pattern day after day may be watching sundowning. Mayo Clinic describes sundowning as a state of confusion that occurs in the late afternoon and lasts into the night. It is not a disease, Mayo explains, but a group of symptoms that shows up at a specific time of day and may affect people with Alzheimer’s disease and other types of dementia. The exact cause is not known.

The National Institute on Aging puts it this way on its page about coping with agitation, aggression, and sundowning: “When restlessness, agitation, irritability, and confusion happen as daylight begins to fade, it’s known as sundowning.”

These are the signs the two sources describe.

Confusion that builds as the day goes on. The key clue is timing. Mayo describes confusion that starts in the late afternoon and continues into the night.

Restlessness, agitation and irritability. NIA names all three as part of sundowning.

Anxiety. Mayo lists anxiety among the behaviors sundowning can cause.

Aggression or ignoring directions. Mayo includes both. A loved one who cooperates in the morning may resist help in the evening.

Pacing or wandering. Mayo says sundowning can lead to both.

Mayo also lists factors that may make late-day confusion worse: fatigue, a day spent somewhere unfamiliar, low lighting, increased shadows, disruption of the body’s internal clock, trouble separating reality from dreams, being hungry or thirsty, an infection such as a urinary tract infection, being bored or in pain, and depression. NIA notes that being overly tired can increase late-afternoon and early-evening restlessness.

Both sources offer practical steps for the household. Mayo suggests keeping a predictable routine for bedtime, waking, meals and activities, planning activity and light exposure during the day, limiting daytime naps, and keeping caffeine and sugar to the morning. In the evening, it suggests a night light, less background noise and stimulation, including TV that can be upsetting, and familiar, gentle music. In an unfamiliar setting, familiar items such as photographs can help.

NIA’s list is similar. Stick to a schedule. Arrange time outside or by a window for sunlight each day. Aim to be physically active each day without planning too many activities. Avoid alcohol and caffeine late in the day, and discourage long naps and dozing late in the day.

Keeping notes can help when you talk to a professional. Write down what time the changes start, what happened earlier that day, and what seemed to calm things down.

Some changes call for a call to the doctor. Mayo says a medicine side effect, pain, depression or another condition could contribute, and that a urinary tract infection or sleep apnea could be a factor, especially if sundowning comes on quickly. A sudden change is a reason to call, not wait. Before trying any sleep aid or supplement, ask a clinician. NIA advises that in an emergency, you should call 911 and explain that your loved one has dementia.

Caregivers carry a lot in these hours, too. NIA’s page lists resources, including its Alzheimer’s and related Dementias Education and Referral Center at 800-438-4380 and the Eldercare Locator at 800-677-1116. Only a clinician can sort out what is driving the changes after an exam.

This article is for general information and is not medical advice. Talk with your loved one’s doctor about new or worsening confusion, and call 911 in an emergency. This article was produced with the assistance of AI and fact-checked against the sources cited by LightWave Reports.