Why the late afternoon gets harder with dementia, and what actually helps

By Lee-Ann Clark · 8 years in dementia and Alzheimer's care

If you've noticed that things seem to fall apart around 3 or 4pm, more agitation, more confusion, more distress than the rest of the day, you're not imagining it. There's a name for it. It's called sundowning, and if you're dealing with it, you already know it's one of the most exhausting parts of dementia care.

Nobody fully understands why it happens. But we know the brain's internal clock gets disrupted by dementia, and by late afternoon, a day's worth of tiredness, fading light, and accumulated confusion all land on top of each other at once. What comes out the other side is often anxiety, restlessness, or a kind of desperate searching, for home, for a person, for something they can't quite name.

I've sat with residents who were completely settled at lunchtime and unrecognisable by early evening. Pacing. Asking for a mother who died decades ago. Trying to leave for a job they retired from years back. It can feel frightening the first time you see it, both for them and for you.

What's actually happening

The short version: their brain is more tired than yours by that point in the day, even if it doesn't look like physical tiredness. Processing the world all day, every day, with dementia takes real cognitive effort. By late afternoon, that reserve is running low, right around the same time the light starts to change and shadows lengthen, which can itself be disorientating.

What tends to help

• Shift the calm things earlier. If there's something that reliably settles them, a favourite playlist, a short walk, a cup of tea and an old photo album, try moving it to early-to-mid afternoon, before the difficult window usually starts. You're getting ahead of it rather than trying to manage it once it's already arrived.
• Keep the environment steady as the light changes. Turning lamps on before it gets properly dark, rather than waiting until the room's already gloomy, can help keep things feeling settled rather than shifting suddenly.
• Don't argue with the story. If they're convinced they need to leave for work, or that their mother is expecting them, correcting the facts rarely helps and can make the distress worse. It's usually kinder and more effective to step into the feeling underneath the words, they want to feel needed, or safe, or that someone's expecting them, and answer that instead.
• Watch caffeine and stimulation later in the day. A stimulating television programme or too much caffeine in the afternoon can make the difficult window harder, even if it wouldn't have affected them the same way years ago.

It won't work every day

Some days, nothing helps and you just have to get through it. That's not a sign you're doing it wrong. Sundowning is one of the more stubborn parts of dementia, and even good routines don't fix it every single time. What tends to help most carers isn't a perfect solution, it's building a softer, more predictable rhythm into that part of the day, so that even on the hard afternoons, there's less working against you.

If sundowning is becoming a daily, significant struggle, it's worth mentioning to their GP. There can sometimes be other things contributing, pain that's harder to communicate late in the day, or medication timing, that are worth ruling out.

You might also find this useful: Why someone with dementia stops eating properly, and what to do about it · Or read about why they keep asking to go home, and what to say.