What Are the Symptoms of Sundowners?

Caring for a loved one with memory loss can be challenging - especially when behaviors seem to change later in the day. If you’ve noticed increased confusion, agitation, or restlessness in the late afternoon or evening, your loved one may be experiencing sundowners, also known as sundowning syndrome.

At Bagnell Brain Center, we work closely with families navigating cognitive decline and neurodegenerative conditions. Understanding the symptoms of sundowners is the first step toward finding compassionate, effective support.
 

What Is Sundowning?

Sundowning refers to a pattern of worsening confusion and behavioral changes that occur in the late afternoon, evening, or nighttime. It is most commonly associated with Alzheimer’s disease and other forms of dementia, though it can also occur in individuals with other neurological conditions.

While the exact cause isn’t fully understood, factors such as fatigue, low lighting, hormonal shifts, disruption of the body’s internal clock (circadian rhythm), and overstimulation may contribute to these symptoms.

Sundowning symptoms can vary from person to person, but they typically follow a predictable pattern later in the day. Here are the most common signs to watch for.
 

Increased Confusion

A person who seemed relatively clear earlier in the day may become disoriented in the evening. They may:

• Forget where they are
• Have trouble recognizing familiar people
• Struggle to follow conversations
• Become unsure of the time or date

This confusion often intensifies as daylight fades.
 

Agitation or Irritability

Even mild frustration can escalate quickly during sundowning episodes. Individuals may:

• Raise their voice
• Become easily upset
• Resist care or assistance
• Display sudden mood swings

What may appear as anger is often fear or anxiety triggered by confusion.
 

Restlessness or Pacing

Physical restlessness is common. You may notice:

• Repetitive movements
• Pacing back and forth
• Wandering
• Difficulty sitting still

This behavior can increase the risk of falls or injury if not carefully monitored.
 

Anxiety and Fearfulness

As cognitive clarity declines, a person may feel unsafe or uncertain. Symptoms can include:

• Paranoia
• Suspicion of others
• Clinginess
• Statements about needing to “go home” (even when already home)

Shadows and dim lighting can worsen these feelings.
 

Hallucinations or Delusions

Some individuals experience visual or auditory hallucinations during sundowning episodes. They may:

• See people or objects that aren’t there
• Believe something untrue with strong conviction
• Misinterpret ordinary situations

These experiences can be very real and distressing for the individual.
 

Sleep Disturbances

Sundowning often disrupts normal sleep patterns. Signs include:

• Difficulty falling asleep
• Frequent nighttime waking
• Daytime drowsiness
• Reversed sleep-wake cycles

Sleep disruption can further worsen cognitive symptoms the following day.
 

Managing Sundowning at Home

While medical evaluation is important, simple daily strategies can also help reduce symptoms:

• Maintain a consistent daily routine
• Increase exposure to natural daylight
• Keep evening lighting bright and even
• Reduce noise and stimulation late in the day
• Offer reassurance and calm communication
• Limit caffeine and sugar
• Encourage gentle daytime activity

Small environmental adjustments can lead to noticeable improvements.
 

Take the Next Step Toward Clarity and Support

Sundowners can be one of the most distressing aspects of cognitive decline - for both patients and caregivers. Increased confusion, agitation, anxiety, restlessness, and sleep disruption in the late afternoon or evening are hallmark signs. While the symptoms can feel overwhelming, they are manageable with the right approach and medical guidance.

If your loved one is experiencing symptoms of sundowners or worsening memory changes, Bagnell Brain Center is here to help. Our comprehensive neurological evaluations and personalized care plans are designed to uncover the root causes and provide meaningful solutions. Visit our office in Pinecrest, Florida, or call (305) 889-7488 to book an appointment today.