Understanding the Link Between Late-Day Behaviors and Care Decisions

What’s the hardest part of caregiving for you?

Is it managing your loved one’s sleep? Their agitation during the evening?

Maybe it’s watching their mood and behavior change as the day progresses.

These changes can catch caregivers off guard. One moment, a person with dementia may seem calm, and then, without much warning, they become anxious or confused. This late-day behavior is known as sundowning.

At The Cordwainer in Norwell, MA, we hear from family members every week who are trying to make sense of these shifts. Our memory care community is dedicated to transforming the way the public perceives dementia-related behaviors. We’re proud to bring new ideas to memory care in Massachusetts and help families feel less alone.

Let’s explore sundowning, what causes it, and how to support someone experiencing this side effect of dementia.

What Is Sundowning in Dementia?

Sundowning refers to a set of behavioral changes that typically happen during the late afternoon or evening. These changes may include:

• Irritability or anger
• Anxiety or restlessness
• Pacing or wandering
• Crying or yelling
• Confusion about time or surroundings

Some caregivers describe sundowning symptoms as unpredictable or exhausting. But while the exact causes are not fully understood, sundowning’s meaning is linked to biological and environmental changes in the brain.

It is often a pattern that repeats daily, tied to the body’s internal clock, also known as the circadian rhythm. As Alzheimer’s and other forms of dementia progress, the brain has more difficulty regulating that clock.

What Causes Sundowning?

Sundowning in dementia does not have a single cause. Instead, it’s often the result of overlapping triggers that build up throughout the day. Here are some of the most common:

• Fatigue: Mental and physical exhaustion can worsen symptoms.
• Changes in Light: Lower levels of natural light during evening hours can increase confusion.
• Hunger or Thirst: Unmet needs may lead to behavioral outbursts.
• Overstimulation: Crowds, noise, or unfamiliar routines can cause distress.
• Unmet Physical Needs: Pain, urinary tract infections, or sleep apnea may go unnoticed.
• Underlying Medical Conditions: These can impact how the brain responds to stress or stimulation.

Another contributing factor could be medications. In some cases, medications that were once helpful may begin to cause side effects as dementia progresses.

Can Medications Cause Sundowning?

Some medications can contribute to sundowning behaviors. These effects are more likely in older adults, whose bodies may process medications differently. Medications that cause drowsiness, confusion, or affect mood can trigger or worsen sundowning symptoms.

Sundowning medication effects can occur with:

• Antipsychotic medications, particularly when doses are too high
• Sleep aids that affect natural sleep cycles
• Blood pressure medications that cause dizziness
• Anti-anxiety drugs that create confusion
• Pain medications with sedating side effects

Even medications used to manage Alzheimer’s may need to be adjusted over time. If sundowning begins after a medication change, talk with a doctor or pharmacist. They can review whether medications contributing to sundowning may be involved.

How to Manage Sundowning

Sundowning is challenging, but it can often be reduced with some routine changes and attention to triggers.

Some of the best approaches include:

• Keeping the daily schedule predictable and consistent
• Limiting caffeine, sugar, and naps late in the day
• Closing blinds and turning on lights before sunset to reduce shadows
• Playing soft music to create a calm environment
• Avoiding large meals late at night
• Offering light snacks and hydration throughout the day
• Minimizing noise and overstimulation in the evenings

Some families also find success by incorporating music therapy or engaging activities, such as puzzles or art, earlier in the day, when energy levels are higher. These activities can reduce agitation and improve cognitive decline outcomes over time.

Tips for Caregivers Dealing With Sundowning

Family caregivers managing sundowning need strategies that work for both the person with dementia and themselves.

Daily Observation Strategies

• Track the time of day when behaviors occur
• Note what the person ate, drank, or did before episodes
• Look for patterns in weather, visitors, or routine changes
• Keep a simple log to identify trends

Prevention Approaches

• Create calm spaces before agitation begins
• Use consistent caregiving routines
• Address basic needs like bathroom breaks, food, and comfort
• Remove triggers like loud television or bright overhead lights

Support Resources

• Use respite care services to get breaks from caregiving
• Join support groups for family members
• Consider adult day programs for social interaction
• Ask healthcare professionals when sundowning symptoms increase

Address sleep problems promptly. Poor nighttime rest makes daytime behaviors worse. Ask doctors about sleep studies if needed. Some people benefit from treating conditions like sleep apnea.

You do not have to solve everything alone. Many family members find sundowning to be one of the most stressful parts of caregiving. Reaching out for support or professional memory care can be a vital step.

How The Cordwainer Supports Residents With Sundowning

At The Cordwainer, we understand that sundowning behaviors are deeply personal and often misunderstood. That’s why our approach includes:

• Programming that emphasizes structured routines
• Bright indoor spaces using natural light to support circadian health
• Trained team members who understand neuropsychiatric symptoms
• Music, language, and arts-based enrichment to calm and engage
• A focus on daily rhythms, emotional needs, and secure surroundings

Our team is experienced in supporting those with dementia and their families. Our focus on wellness, personalized care, and a soothing environment makes our community in Norwell, MA, a leader in memory care.

Get Support for Managing Dementia Near You

If you are managing care for someone with memory loss, know that resources are available. Sundowning can be challenging, but it is not a reflection of failure. It’s a signal that the brain needs more support, often both medical and environmental.

The Cordwainer is redefining what dementia support looks like in the Boston, Massachusetts area. We’re proud to offer a memory care program that puts well-being at its center. With spaces designed for calm and learning opportunities that inspire, we’re here to help you take the next step with confidence.

Schedule a visit or contact our team to learn how we can support your family.