When Evenings Become Challenging

For those who care for a client or loved one living with brain change, the hardest part of the day often begins just as the sun goes down.

A parent who has been calm all afternoon may suddenly become anxious, restless or confused. They may pace the house, repeatedly ask the same questions or insist they need to leave to “go home” — even when they’re already there.

This phenomenon, known as sundowning, is common among people living with brain change. While it can be distressing for both the person and those caring for them, understanding why it happens can make it easier to respond with patience and compassion.

According to the Alzheimer’s Association, sundowning is increased confusion that people with Alzheimer’s disease and other forms of dementia may experience from dusk through the night. It isn’t a disease itself but rather a collection of behaviors that can include anxiety, agitation, pacing, hallucinations, sleep disturbances and disorientation.

“The important thing for families to remember is that these behaviors aren’t intentional,” said Rachel O’Brien, Community Liaison for Cambridge Caregivers’ Fort Worth office. “Your loved one isn’t trying to be difficult. Their brain is processing the world differently, and they need reassurance rather than correction.”

Why Does Sundowning Happen?

Researchers don’t fully understand why sundowning occurs, but several factors appear to contribute.

A person with brain change may simply be mentally and physically exhausted after a full day of activity. The disease also affects the brain’s internal clock, disrupting normal sleep-wake cycles and making late afternoon and evening especially confusing.

Changes in lighting may play a role as well. As daylight fades, shadows lengthen and familiar surroundings can begin to look unfamiliar or even frightening. Hunger, pain, an overstimulating environment or a change in routine may also trigger symptoms.

As Angela Thomas, MSN, RN, CMC, Founder and President of Caring with Grace in Dallas, wrote in a recent blog, “Their behavior is not intentional or willful, though it is plenty stressful for you!”

Working With the Person’s Natural Rhythms

One of the most effective ways to reduce sundowning is to work with — rather than against — the body’s natural daily rhythms. When possible, encourage your loved one to spend time outdoors or near natural light during the day. Exposure to sunlight helps reinforce the body’s internal clock, making it easier to distinguish day from night.

Just as important, create an environment that supports sleep once evening arrives. Keep the bedroom as dark as possible overnight, maintain a consistent bedtime routine and avoid excessive television or other screen time immediately before bed. Bright screens and stimulating programming can increase confusion or make it harder to fall asleep.

Scheduling demanding activities such as bathing, appointments or errands earlier in the day, when many people are more alert, can also reduce evening fatigue.

Responding With Calm and Compassion

When sundowning occurs, arguing or trying to convince someone they’re mistaken usually makes matters worse. Instead, experts recommend responding calmly, offering reassurance and gently redirecting the conversation.

At Cambridge Caregivers, team members receive specialized training that prepares them to respond thoughtfully when clients become confused or agitated. Caregivers learn to observe patterns by making notes about what happens before sundowning episodes, helping identify possible triggers that families can address.

They also learn communication techniques that reduce anxiety rather than increase it.

One technique is to enter the client’s reality instead of trying to force them into ours.

Suppose an older woman becomes upset every afternoon because she believes it’s time to pick up her young children from school. Telling her that her children are now middle-aged adults living in other cities probably won’t ease her anxiety. Instead, a caregiver might respond, “Don’t worry. Someone is picking them up for us today.”

Meeting the person where they are emotionally often provides far greater comfort than insisting on factual accuracy.

“It’s about entering their world instead of expecting them to enter ours,” Rachel said. “When we validate what they’re feeling and redirect gently, we can often reduce fear and help them feel safe.”

Other calming strategies may include listening to familiar music, looking through family photographs, accompanying the client on a short walk or simply sitting quietly together.

Support for the Whole Family

Sundowning can be one of the most exhausting aspects of caregiving, especially for family members who are already balancing work, children and other responsibilities. Professional caregivers can provide respite for family caregivers and reassurance for clients. They can also help families recognize patterns, establish calming routines and adapt care as brain change progresses.

With patience, consistency and compassionate support, many families find that evenings become more peaceful, for everyone involved.