Understanding Sundowning: Why Shorter Days Trigger Anxiety and Confusion in Elders with Dementia

As daylight fades, many caregivers and loved ones tend to notice a familiar and difficult shift in an elder’s behaviour. Moments that were calm earlier in the day may give way to anxiety, distress, pacing, or even aggression. This change is referred to as sundowning, and it is a common experience for elders living with dementia. It can be deeply unsettling for both the individual and the caregiver supporting them.

A key explanation for this phenomenon lies in the disruption of the body’s internal clock, better known as the circadian rhythm.

Neha Sinha, Dementia Specialist and Clinical Psychologist, Co-founder & CEO, Epoch Elder Care, explains, “When natural light decreases, especially during shorter winter days, the brain struggles to process the signals that regulate sleep, wakefulness, and emotional stability. For someone with dementia, this reduced light becomes more than an environmental change; it becomes a trigger for confusion and a sense of internal disorientation.”

What Sundowning Feels Like

For an elderly person, sundowning can feel like losing clarity as the world becomes dimmer. The symptoms: confusion, anxiety, agitation, restlessness- may be common across experiences, but how intensely they appear varies widely.

“Many elders begin pacing, following caregivers closely, seeking reassurance, or reacting to internal fears that feel very real to them. Some may become demanding, overwhelmed by delusions, or unable to recognise familiar surroundings,” explains Neha Sinha.

These behaviours often stem from fear, unmet needs, and sheer exhaustion. When the brain can no longer accurately interpret signals of fatigue or environmental changes, emotional overload becomes almost inevitable.

And for caregivers, these moments can test patience, resilience, and emotional strength. The exhaustion on both sides, whether physical or emotional, can compound the challenge.

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The Biological Trigger

As per Neha Sinha, “The brain’s internal clock is governed by the suprachiasmatic nucleus (SCN), a tiny yet crucial region that interprets light signals. In dementia, the SCN gradually deteriorates, affecting production of melatonin and acetylcholine, chemicals essential for maintaining a steady sleep-wake (circadian) cycle.”

As days shorten and evenings darken earlier, this disrupted system grows even more unstable. The individual may feel tired yet unable to rest, confused yet unable to orient themselves to day or night. This biological turbulence often surfaces as agitation around sunset, a psychological crisis triggered by a failing internal rhythm.

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Environment, Fatigue & Unmet Needs

As per dementia specialist Neha, “Low light can make familiar spaces appear distorted or threatening to an elder with dementia. Shadows may be misinterpreted, objects may become unrecognisable, and the sense of safety may waver.”

By late afternoon, sensory overload from the day, noise, activity, and interactions has accumulated. Basic unmet needs such as hunger, thirst, pain, or discomfort can intensify confusion. And because communication becomes difficult, these needs often surface through behavioural changes instead of words.

The combination of fatigue, poor visibility, and unmet physical needs makes the evenings especially fragile. This can also affect the mental health of seniors with dementia.

Supporting an Elder Through Sundowning

Sundowning is not simply a behavioural issue; it is a response to internal decline, disrupted rhythms, and environmental stress. Understanding this helps caregivers respond with empathy rather than frustration.

Small, thoughtful adjustments can make evenings significantly smoother. Listed below are some suggestions by expert Neha Sinha:

• Establishing a consistent late-afternoon routine to signal safety and predictability.
• Introducing soft, even lighting before sunset to minimise shadows and visual misinterpretation.
• Reducing noise, crowds, and complex stimulation as evening approaches.
• Addressing physical needs early. This includes hydration, nutrition, toileting, pain management, etc., before fatigue peaks.
• Offering calm reassurance and familiar activities rather than new demands or corrections.

Final Word

These interventions do not eliminate sundowning, but they can soften its intensity. Most importantly, they preserve dignity, allowing the elderly to feel safe, supported, and understood at a time when their internal world feels increasingly unstable. For caregivers, this shift from control to compassion can ease not just evenings, but the emotional weight of care itself.