What is sundowning?

Common signs and symptoms

Sundowning affects each person differently, but common signs may include:

Emotional changes

• Increased anxiety or fear
• Low mood or tearfulness
• Irritability or emotional sensitivity

Behavioural changes

• Restlessness or pacing
• Repetitive questioning
• Calling out or seeking reassurance
• Resistance to personal care
• Increased confusion about time or place

Physical and sleep-related changes

• Difficulty settling in the evening
• Disrupted sleep patterns
• Day and night confusion
• Increased wandering risk

Symptoms often follow a similar daily pattern, making evenings particularly challenging for live-in carers.

Why does sundowning happen?

There is no single cause of sundowning. Instead, it is thought to result from a combination of neurological, physical, and environmental factors.

Changes in the body clock

Dementia can affect the brain’s ability to regulate circadian rhythms. As a result, the natural signals that distinguish day from night may become less clear.

Fatigue and cognitive overload

By late afternoon, many people are mentally and physically tired. As energy levels drop, coping mechanisms weaken, and confusion can increase.

Reduced lighting and visual changes

As daylight fades, shadows lengthen, and familiar spaces can appear unfamiliar. This can increase anxiety or lead to misinterpretation of surroundings.

Unmet physical needs

Hunger, thirst, pain, constipation, or discomfort may become more noticeable in the evening, particularly if communication is difficult.

Environmental triggers

Noise, busy households, visitors or changes in routine later in the day can contribute to agitation and restlessness.

Understanding individual triggers is an important step in reducing distress and supporting calmer evenings.

Who is most affected?

Sundowning is most often associated with:

• Alzheimer’s disease
• Vascular Dementia
• Lewy body dementia
• Mixed dementia

Not everyone living with dementia will experience sundowning, and the severity can vary over time. Symptoms may fluctuate, improving or worsening depending on health, environment, and routine. Events such as illness, hospital stays, or moving away from familiar surroundings can sometimes make sundowning more noticeable.

The emotional impact on families

Sundowning can be distressing not only for the individual but also for the people supporting them. Carers often describe evenings as tense or exhausting, especially when reassurance is needed repeatedly, or sleep becomes disrupted.

Over time, this can lead to emotional strain and fatigue for live-in carers. Recognising the impact on your own wellbeing is important. Support is not about replacing the live-in carer but about strengthening it and ensuring that care remains sustainable. We will always try to ensure that you, as our carers, get the support and help needed, but we need to know when you feel things are changing.

Supporting someone with sundowning at home

While sundowning cannot always be prevented, many carers find that consistency, calm and reassurance can significantly reduce distress

Establishing a steady daily routine

Predictable routines help create a sense of security. Regular times for meals, activities, rest, and bedtime can reduce anxiety as the day progresses.

Supporting daylight exposure and activity

Exposure to natural daylight and gentle daytime activity may help regulate sleep patterns and reduce restlessness later in the day.

Creating a calm evening environment

• Gradually increase lighting as daylight fades
• Reduce background noise and visual clutter
• Avoid overstimulation from television or busy household activity
• Keep surroundings familiar and uncluttered

Offering reassurance rather than correction

When confusion increases, correcting facts can sometimes increase distress. Calm reassurance, validation, and distraction are often more effective.

Supporting comfort and wellbeing

Ensuring comfort, hydration, and appropriate support with pain or discomfort can make a noticeable difference to evening behaviour.

How Featherbed live-in care can help with sundowning

For many families, sundowning is one reason they explore live-in care. Having a dedicated carer in the home provides reassurance and practical support during the most challenging times of day. We are not always aware of the full 24-hour routine when we carry out an assessment, and it may not become apparent at the start of the placement. We rely on our carers to update the agency on any changes in needs and outcomes so we can help support you to provide the full care required.

As a specialist provider of live-in care, we support individuals by remaining in the comfort of their own home, with care that adapts to changing needs and routines.

Continuity and familiarity

A consistent carer builds trust and understands individual routines, preferences and triggers. This continuity is particularly valuable throughout evenings and nights.

Calm companionship

A live-in carer can offer gentle companionship and emotional reassurance, helping to reduce feelings of isolation, fear or agitation.

Support through the night

Sundowning does not always stop at bedtime. A live-in carer can provide reassurance, support with personal needs and help ensure safety if someone wakes during the night.

Reduced pressure on family members

Knowing that experienced support is in place allows families to rest, reducing exhaustion and helping them remain emotionally resilient.

Remaining at home

Staying in familiar surroundings can significantly reduce confusion. Live-in care supports independence while avoiding the disruption that can come with residential moves.

When to seek further advice

If sundowning symptoms suddenly worsen or appear alongside new physical symptoms, it is important to seek advice from a GP or healthcare professional. While this guide does not provide medical advice, changes can sometimes be linked to treatable causes such as infection or discomfort.

Organisations such as Age UK and the Alzheimer’s Society can also offer guidance, practical information and emotional support for families.

Reassurance for the future

Sundowning can feel overwhelming, but many carers find that with the right understanding and support, evenings become more manageable. Small adjustments, consistency, and compassionate care can make a meaningful difference.

A live- in carer offers a flexible, personalised approach that evolves as needs change, supporting both the individual and the people who care about them.