What You Can Do When Dementia Symptoms Get Worse at Night

Evenings are supposed to bring a sense of calm. But for many caregivers supporting a loved one with dementia, the hardest hours begin just as the sun starts to set. Instead of resting, the person you care for may become restless, confused, or frightened. They may pace from room to room, insist they need to go somewhere, or express anger they cannot explain. If this sounds familiar, you are not alone. Many families experience these late day symptom changes, often called sundowning. And although it can feel overwhelming, there are practical steps that can ease this tension for both of you.

In this post, we will explore what sundowning truly is, why it happens, and what you can do to create calmer evenings. You will learn how to support your loved one’s brain, how to reduce agitation, how to build evening routines, and how to respond with confidence rather than fear. Most important, you will understand that none of this is your fault. You are doing your best in a situation that challenges even the most seasoned caregivers, and you deserve tools that work.

Understanding What Sundowning Really Is

Sundowning is more than a reaction to the time of day. It is a constellation of symptoms that arise when the brain becomes overwhelmed. As the day progresses, fatigue accumulates. The ability to interpret sound, light, and movement declines. Shadows may seem confusing, familiar rooms begin to look unfamiliar, and ordinary noises feel startling. This shift can leave a person with dementia feeling vulnerable, disoriented, and afraid.

This fear can show up in different ways. They might pace, ask repetitive questions, or insist they need to go home even when they already are home. They may misunderstand bedtime as a threat or become tearful without being able to express why. Some may become combative because they feel unsafe. Although these behaviors may feel unpredictable, they often reflect the brain trying to grasp what is real and what is not.

At its core, sundowning is not defiance. It is not stubbornness. It is a brain working hard to stay connected to a world that feels increasingly confusing. When you understand this, your role shifts from correcting to supporting. And that shift can bring both of you relief.

Step 1: Build a Gentle Evening Routine

Structure is one of the most powerful tools you can use. The brain does best when it knows what to expect. A simple evening routine can reduce agitation by signaling safety.

Begin with predictable transitions. After dinner, gradually dim the lights so the mind can settle. Offer calming activities that feel familiar and reassuring such as folding towels, brushing hair, or looking through old photos. These tasks are soothing because they tap into long term memory, which is often preserved longer than short term memory.

Aim for consistency in timing. Try to avoid surprises or big changes after six in the evening. The goal is not to force sleep but to create an environment where rest feels possible. When the nervous system feels safe, sleep is far more likely to follow.

There are also a few things to avoid if possible. Loud or competing noises, such as a television and radio playing at the same time, can increase confusion. Long naps after mid afternoon can disrupt sleep rhythms. Unfamiliar visitors in the evening can feel especially destabilizing for a tired brain.

A gentle routine may not solve every challenge, but it creates a foundation for peace. And on the hardest nights, that foundation matters.

Step 2: Use Visual Anchors and Comfort Signals

For many people with dementia, the boundary between day and night becomes blurry. Visual cues help restore that clarity. A soft nightlight in the hallway or bathroom provides orientation without glare. Closing curtains before sunset prevents confusion about shapes or movement outside.

A large analog clock that shows day and night colors can reinforce time cues. These small adjustments anchor the brain and reduce the cognitive load required to interpret the environment.

Comfort items also play an important role. A familiar blanket, a favorite pillow, or a stuffed animal can act as emotional rootedness. A photograph of a loved one, labeled with a name, can soothe even when the person cannot recall details. Some caregivers find that a short written note such as “You are safe. It is bedtime. I am here with you” offers gentle reassurance during moments of confusion.

Even when memory fades, emotional understanding remains strong. Your presence, your tone, and these small visual signals can shape their sense of security.

Step 3: Respond to Behavior, Not Just Words

When your loved one insists they must get home or that something bad is happening, it is natural to want to correct them. But in dementia care, correction often increases distress. Their words may not reflect literal meaning. Instead, they reflect a feeling. Home may represent safety, comfort, or belonging.

Rather than trying to explain, try to connect. You might say, “Tell me about home.” This validates the feeling and opens space for conversation instead of conflict. Or, “Let us sit together for a moment, then we will decide what to do.” This slows the moment and helps the nervous system reset. You can also offer gentle reassurance: “You are safe. I am here with you.”

These approaches do not dismiss their experience. They acknowledge the underlying need, which is often reassurance. When that need is met, the urgency of the behavior often softens.

Step 4: Track Patterns and Clues

Sundowning feels unpredictable until you start noticing patterns. A simple journal can help. Write down the time symptoms begin, what they ate, whether they napped, any visitors, and changes in weather or light. After a week or two, themes often emerge.

You may notice symptoms are worse on cloudy days, after large meals, or on days with unusual activity. Maybe skipping an afternoon walk makes the evening harder. These observations allow you to anticipate challenges and adjust the day’s structure in small ways that create significant improvements.

Even when the brain is affected by dementia, behavior still follows patterns. When you recognize those patterns, you gain power and clarity.

Step 5: Know When to Call the Doctor

Not every change is simply part of the disease. If agitation is new, suddenly worse, or accompanied by fever, pain, or changes in walking or eating, contact the doctor. Sudden shifts can signal infection, medication effects, dehydration, or other treatable conditions. You know your loved one best. If your intuition tells you something is not right, trust it. Speaking up is not overreacting. It is leadership.

You Are Not Alone

Caring for someone during the hardest hours of the day requires strength, patience, and compassion. While most people are settling into rest, you are staying alert and doing everything you can to create calm in moments of confusion. That is not failure. That is courage.

Your loved one may forget what you say, but they will not forget how you make them feel. You are offering safety in a world that feels unpredictable to them. And that impact is profound.

Remember, You are MORE than just a giver of care - You are a CARE LEADER!

Anna Thomas

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The views and opinions expressed in this post are solely my own and do not reflect the views of any past or present employer of Dr. Thomas. This content is for educational and informational purposes only and is not intended as medical or legal advice.