Sundowning: Evening Support and When to Seek Medical Help

By Silver Sitters

Sundowning describes a pattern of increased confusion, restlessness or distress in the late afternoon or evening in some people with dementia. It is a description of symptoms, not a separate disease or an explanation for every change in behavior.

Do not assume sudden confusion is sundowning

Call 911 if confusion starts suddenly. Also seek emergency help if the person becomes unconscious, has confusion after a head injury or is at immediate risk of harming themselves or others. Do not wait for evening to pass or try to manage an acute change with a new routine alone.

Discuss recurring evening difficulties with the treating clinician. Pain, medicine effects, infection or sleep problems may contribute. Describe when symptoms started and how they differ from the person’s usual behavior.

Try an individualized evening plan

• Keep familiar times for meals, waking and bedtime, with flexibility for the person’s needs.
• Plan more demanding activities when the person is usually most alert. Balance activity with rest rather than trying to exhaust them.
• Provide comfortable lighting that reduces confusing shadows. Keep walking routes clear.
• Reduce upsetting noise or stimulation. Offer a familiar quiet activity if the person enjoys it; there is no universal ban on reading or television.
• Discuss caffeine, alcohol, nicotine and medication timing with the clinician. Caffeine late in the day can interfere with sleep; do not change prescribed medicines on your own.

Respond to distress calmly

Approach without arguing, allow personal space and check whether the person needs help with discomfort, toileting or another immediate need. A calm response may help, but it does not guarantee the symptoms will stop. Record patterns and what helped so the care team can review them.

Ask the clinician before adding sleep aids or supplements. Medication decisions require consideration of benefits and risks, and new or worsening symptoms need assessment.

Plan support for the family as well

Palm Beach County families arranging evening help should agree on the actual hours, tasks, contacts and backup coverage. Make sure someone can respond in person when needed. If the current arrangement cannot meet the person’s needs, discuss a different level of support with the care team.