Why does dementia get worse at night? Sundowning

Quick summary

Late afternoon and evening are when dementia often gets hardest, and it has a name: sundowning. The exact cause is not fully understood, but tiredness, fading light, hunger, pain and a disrupted body clock all seem to play a part. A steady routine, daylight early in the day and a calm evening tend to help more than anything else.

What is sundowning?

A pattern where someone with dementia becomes more confused, anxious, agitated or restless in the late afternoon and evening. Alzheimer’s Society describes it as behaviour that can be difficult to understand in the late afternoon or early evening, and notes that people may become intensely distressed or agitated and may have hallucinations or delusions (Alzheimer’s Society, Sundowning).

It is not a separate condition. It is a set of symptoms that tends to cluster at a particular time of day. Estimates of how many people with dementia experience it vary widely between studies.

What does it look like?

• Restlessness and pacing, often around the same time each day.
• Wanting to leave, “to go home”, sometimes from the home they have lived in for decades.
• Increased confusion about where they are or who people are.
• Anxiety, irritability or tearfulness.
• Suspicion, including believing things have been taken.
• Seeing or hearing things that are not there, particularly as the light fades.
• Difficulty settling to sleep, or waking and wandering at night.

Why does it happen?

Nobody knows for certain, and it is probably several things at once.

What helps during the day

• A regular routine. Getting up, meals and bedtime at similar times each day.
• Daylight in the morning. Time outside, or sitting by a window, helps the body clock.
• Activity earlier in the day. Appointments, bathing and outings in the morning when people are usually more alert.
• Not too much napping late in the day, which makes night-time sleep harder.
• Less caffeine and alcohol in the afternoon and evening.
• A bigger meal at lunchtime and a lighter evening meal.

What helps in the evening

• Put the lights on before it gets dark, and close the curtains, so the change from day to evening is less stark and reflections in windows do not confuse.
• Keep it calm. Less noise, fewer people, and the television off if it is adding to the confusion.
• Something familiar to do. Folding towels, looking at photographs, music they know.
• Check the basics. Hungry, thirsty, in pain, too hot or cold, needing the toilet.
• Do not argue. Reassure, respond to the feeling, and redirect gently.
• Let them walk if it is safe. Stopping someone who needs to move usually escalates things.

Keep a diary

For a week or two, write down when the difficult time starts, what happened just before, what they had eaten and drunk, and what helped. Patterns often show up that are not obvious day to day, such as distress always following a particular visitor leaving or a missed afternoon drink.

It is also useful to take to the GP or memory service.

When it is not sundowning

If evening confusion comes on suddenly, or is much worse than usual over a day or two, it may be delirium rather than sundowning. Delirium has causes that often need treatment, such as an infection.

The NHS advice is to go to A and E or call 999 if someone suddenly becomes confused (NHS, Sudden confusion). The key difference is the pattern. Sundowning tends to follow a similar shape most evenings. A sudden change from their usual is a medical question.

What about medication?

Non-drug approaches are usually tried first. Sometimes medication is considered where distress is severe and other approaches have not helped. That is a decision for the GP or specialist, who will weigh up benefits and risks, including the risk of falls and drowsiness. Do not start, stop or change any medicine without speaking to them.

Looking after yourself

Sundowning tends to arrive exactly when a family carer is most tired, and it can go on into the night. Broken nights, week after week, wear anyone down.

You are entitled to a carer’s assessment from the council. Support is available from Alzheimer’s Society on 0333 150 3456, and from Cheshire East Carers Hub for family carers in Cheshire East. Evening or overnight support, even a few nights a week, can make the difference between managing and not.

Frequently asked questions

Why is dementia worse at night?

The cause is not fully understood. Tiredness, fading light, a disrupted body clock and unmet needs such as hunger or pain all seem to contribute.

Does sundowning mean the dementia is getting worse?

Not necessarily. It can happen at different stages. A sudden change from someone’s usual pattern should be checked, because it may be delirium.

My mum keeps saying she wants to go home, but she is home. What do I do?

“Home” often means a feeling of safety or a time in life rather than a place. Arguing that she is already home rarely helps. Asking about the home she means, and offering comfort, usually works better.

What if she wanders at night?

Make the route to the toilet safe and lit, and think about door sensors or other technology. If night-time wandering is regular, it is worth talking to the GP and looking at overnight support.

Does sundowning stop?

It varies. For some people it eases as dementia changes. Routine and a calm environment help many people, even if they do not stop it completely.

About Visiting Angels Cheshire East

Visiting Angels Cheshire East provides care at home across Macclesfield, Wilmslow, Knutsford, Congleton, Alsager and the surrounding villages, along with Buxton, Whaley Bridge and the Staffordshire Moorlands towns.

• Evening, overnight and live-in care available, where the late afternoon and nights are the hard part.
• Carers trained in dementia, alongside Parkinson’s, stroke recovery and complex care.
• You see the same faces. Our carer turnover is 12 per cent, against a sector figure of 23.7 per cent (Skills for Care, 2025). A familiar person at the difficult time of day helps.
• You choose your caregiver. You meet them before care starts, and if it is not right you say so and we send someone else.
• No visit is ever shorter than an hour. There is no such thing as a fifteen minute call here.

David’s mother in law is becoming increasingly confused:

“Visiting angels have been a massive help in the care for my mother in law, who is getting increasingly confused. They provide companionship and support every day proving to be very reliable and consistent. They are there at times we can’t be, due to all the commitments of work and grand children.”

David Figg, Google review

Not sure what you need yet? Start with a free assessment

Our free home care assessment is a visit at a time that suits you, with no obligation afterwards. In it we will:

• Work out when the difficult times are, which for sundowning is usually late afternoon and evening.
• Talk through a realistic package, including evening or overnight support, and what it would cost.
• Look at the money with you, including Attendance Allowance and the Council Tax disregard.
• Tell you honestly if you do not need us yet, or if someone else is a better fit.

If the evenings and nights have become the hardest part, call us on 01625 720157. You can also send an enquiry, and you can see what our services cover.

Authored by Dr Niall Jawad, Director, Visiting Angels Cheshire East.

Published 21 September 2026. Last updated 21 September 2026.

This article is general information about sundowning, not medical advice, and no substitute for advice from the GP, memory service or a dementia specialist. Do not start, stop or change any medicine on the basis of this article. If someone becomes suddenly confused, go to A and E or call 999. The author is a director of the company and is not acting in a clinical capacity, and Visiting Angels Cheshire East provides personal care at home rather than medical or nursing care. To the fullest extent permitted by law, GB Care at Home Ltd accepts no liability for any loss or injury arising from reliance on this article.