What is sundowning?
Sundowning is the name for the increased confusion, anxiety and agitation that some people living with dementia experience from late afternoon, through dusk and into the night. The Alzheimer's Association describes it as confusion from dusk through night and lists difficulty sleeping, anxiety, agitation, hallucinations, pacing and disorientation among the signs. It is sometimes called sundowner's syndrome.
Sundowning is part of how dementia affects the brain. It is a pattern, and patterns can be studied and eased. Many families only notice it once the evenings become hard work, but looking back they often realise it has been building for months.
If you are not yet sure whether your parent has dementia, our guide to early signs is a good place to start. Evening confusion on its own does not prove dementia, and a proper medical assessment matters.
Sundowning symptoms: what families usually notice
Every person is different, and the signs can change from week to week. These are the things relatives and caregivers in Lagos describe to us most often:
- Restlessness that starts around four or five o'clock and gets worse as it gets dark.
- Pacing up and down the parlour or corridor, or going in and out of the compound gate.
- Asking to go home, or asking for a parent or spouse who died years ago.
- Not recognising the house, or thinking it is a different time of day.
- Shouting, crying, suspicion of the house help, or accusing people of taking things.
- Seeing people or animals that are not there, often in shadows or dark corners.
- Following one person from room to room and becoming upset when they leave.
- Sleeping in the day and staying awake much of the night.
The behaviour can look deliberate, especially when Mum was perfectly sensible at breakfast. It helps to remember that her brain copes less well as the day goes on. She is struggling, and the evening is when that struggle shows.
What causes sundowning?
No single cause explains sundowning. Dementia can disturb the body clock that tells us when to be awake and when to sleep, and the end of the day brings several pressures at once. The Alzheimer's Association, the US National Institute on Aging and Alzheimer's Society in the UK all describe a mix of physical, emotional and environmental factors. The ones we see most often at home are these:
- Tiredness, both physical and mental, after a long or busy day.
- Fading light. Shadows and dim rooms are easy to misread, so a coat on a door can look like a person.
- Hunger or thirst, especially if lunch was small or early.
- Pain, such as arthritis, toothache or constipation, that your parent may not be able to explain.
- Needing the toilet and not being able to find it or say so.
- Infections, particularly urinary tract infections, which are a common cause of extra confusion in older people.
- Side effects of medicines, or two medicines interacting.
- Too much noise or activity: loud television, visitors, children running around, generator noise.
- A disrupted body clock from long afternoon naps or too little daylight.
- Caffeine late in the day from tea, coffee, cola or kola nut.
- Tension in the house. People with dementia often pick up on a tired or stressed carer.
Most evenings involve more than one of these. Your parent may be tired, a little hungry and sitting in a dim room while the television is loud. Fixing one or two of them can make a real difference.
Sundowning vs delirium: when evening confusion is an emergency
This is the most important part of this guide. Sundowning usually builds slowly and follows a daily pattern. Delirium is different. Delirium is sudden confusion that comes on over hours or a few days, and it is often caused by an illness that needs treatment. The NHS advises that anyone who suddenly becomes confused needs medical help immediately, and lists infections, with urinary tract infections a common cause in older people, as well as stroke, low blood sugar in people with diabetes, head injury and some medicines among the causes.
A person with dementia can develop delirium on top of their usual confusion. Families sometimes put it down to "a bad week" and lose valuable time. Get your parent seen by a doctor the same day if you notice any of the following:
- Confusion that is much worse than usual and came on suddenly, over hours or a day or two.
- Confusion that now lasts all day, not only in the evening.
- A fever, shivering, or feeling hot to the touch.
- A recent fall or knock to the head.
- Very sleepy and hard to wake, or unusually agitated.
- Burning when passing urine, strong-smelling urine, or new wetting accidents.
- Not eating or drinking, vomiting or diarrhoea.
- Slurred speech, a drooping face or weakness on one side.
- A new medicine started in the last few days.
In Lagos, if your parent is very unwell, has stroke signs or cannot be woken, take them to the emergency department of your designated hospital straight away, in the transport you arranged. Agree that hospital in advance, register your parent there, call ahead if you can, and expect to pay a deposit. Bring a list of all their medicines.
It is a medical condition, not stubbornness or a spiritual attack
In many Nigerian families, an older person who becomes confused at night is said to be stubborn, "just old", or under spiritual attack. Some relatives are told the night wandering is witchcraft. These explanations are understandable, because the change in a loved one can be frightening and hard to make sense of. But leaving it there can delay real help, and it can cause great hurt to the person and to whoever is accused.
Dementia is a disease of the brain. Sundowning is one of the ways it shows itself. Faith can be a great comfort to your parent and to you, and prayer and a doctor can go together. Please ask a doctor to assess your parent, ideally one experienced with older people. Some teaching hospitals in Lagos, such as LASUTH in Ikeja, have clinics for older people. Call ahead to confirm what is available, the days the clinic runs and what to bring.
When you go, take a short written account of what happens in the evenings. A doctor can do much more with "agitated from about 5pm most days for two months, worse after visitors" than with "she is confused sometimes".
How to stop sundowning, or at least soften it: the daytime
You may not be able to stop sundowning completely, but many families find it becomes milder and shorter. A calmer evening starts in the morning.
- Keep a steady routine. Wake-up, bath, meals, prayers and bedtime at roughly the same time every day. Predictable days are less tiring for a brain that is struggling.
- Get morning daylight. Open the curtains early, have breakfast by a window, or sit out on the veranda. A short walk round the compound in the cooler morning helps the body clock and uses up restless energy.
- Plan the busier things for the morning. Hospital visits, baths, hair appointments and family calls usually go better before midday.
- Keep afternoon naps short. A short rest after lunch is fine. Long naps late in the afternoon make it harder to sleep at night.
- Move caffeine earlier. Tea, coffee, cola and kola nut are best kept to the morning.
- Keep your parent gently occupied. Folding clothes, shelling beans, looking at photographs or listening to the radio is better than sitting alone with nothing to do.
- Watch drinks and food. Offer water through the day so they are not thirsty in the evening, and make sure lunch is a proper meal.
A calmer evening in a Nigerian home
The hours around dusk need the most planning. Small changes to light, noise and timing help more than most people expect.
- Turn the lights on before it gets dark. Do not wait until the room is dim. Draw the curtains as the light fades so windows do not become dark mirrors.
- Plan for NEPA. A power cut at six o'clock, just as it gets dark, can turn a manageable evening into a frightening one. Keep a rechargeable lamp charged and ready in the sitting room, put one or two lights on an inverter if you can, and keep a torch beside the bed.
- Keep a soft light on at night, and a night light on the way to the toilet. This reduces frightening shadows and helps prevent falls.
- Lower the noise. Turn the television or radio down, avoid loud news or arguments on screen, and keep the generator as far from the bedroom as you can.
- Fewer visitors at dusk. Ask relatives and church or mosque friends to come in the morning or early afternoon instead.
- Serve a simple, light evening meal at the same time each day. Some people with dementia eat better earlier.
- Use what comforts them. Familiar music, hymns, Qur'an recitation, evening prayers or old highlife songs can settle a restless parent. A favourite wrapper or cardigan can help too.
- Keep the bedroom familiar. The same bed, the same mosquito net, the sound of the fan. Many older Nigerians sleep better with the steady hum of a fan, and a sudden silence when the power goes can wake them.
- Toilet before bed, every night, as part of the routine.
What to do in the moment when your parent is agitated
When Dad is pacing and insisting he must go to the office he retired from twenty years ago, logic rarely helps. What helps is a calm person and a change of focus.
- Stay calm and speak slowly. Your tone matters more than your words.
- Do not argue or correct. Telling him the office closed years ago can upset him all over again.
- Reassure him that he is safe and that you are there to help.
- Respond to the feeling behind the words. "You are worried about work. Tell me about it."
- Check the basics: is he in pain, hungry, thirsty, cold, too hot, or needing the toilet?
- Gently redirect. Offer a cup of something without caffeine, a snack, a walk to the veranda, a familiar song or a photo album.
- Turn up the lights and turn down the noise.
- Give him space if he is becoming aggressive, and keep yourself and others safe.
If one approach does not work tonight, try another. It is fine to step away for a minute and breathe if you feel yourself getting upset.
Elderly not sleeping at night
Many families first contact us because a parent has stopped sleeping at night. Sometimes this is sundowning. Sometimes it is pain, needing to pass urine often, breathing problems, low mood, or a medicine taken at the wrong time of day. A doctor should look for these causes, and the Alzheimer's Association specifically mentions checking for problems such as urinary tract infections and sleep apnoea.
Older people often need less sleep than they used to, so a parent who wakes at four in the morning may simply have slept enough. What matters is whether they are distressed, at risk of falling or wandering, and whether the household is getting any rest.
Keeping your parent safe at night
Night-time is when falls and wandering are most dangerous. A few practical steps lower the risk.
- Keep the compound gate locked at night and the keys out of sight.
- Make sure someone in the house knows they are responsible for listening out overnight.
- Clear the route from bed to toilet: no loose rugs, wires or buckets in the way.
- Keep a commode or urinal by the bed if the toilet is far.
- Store kitchen knives, kerosene, medicines and car keys securely.
- Make sure your parent carries or wears something with a family phone number, in case they leave the house.
Keep a simple sundowning diary
A diary is one of the most useful things a family can do. Over two or three weeks it often shows a pattern nobody had spotted, such as worse evenings after a long nap, after visitors, or on days when the light went early. It also gives the doctor real information.
- Date and the time the restlessness started and ended.
- What happened before: nap, visitors, bath, power cut, a new medicine.
- What your parent ate and drank, and when.
- Whether they opened their bowels and passed urine normally.
- What helped and what made it worse.
- How they slept that night.
Medicines: why doctors start with non-drug approaches
It is natural to want something that will make Mum sleep. The Alzheimer's Association says non-drug approaches are encouraged first, that a doctor should check for physical causes, and that medicine may be considered if other measures have not worked, after discussing the risks and benefits.
Please do not give your parent sleeping tablets bought from a chemist, herbal mixtures or anyone else's medicine without speaking to their doctor. Bring every medicine they take, including supplements and local remedies, to each appointment so the doctor can check for side effects and interactions.
When the evenings become too much for the family
Sundowning is exhausting. The hardest hours come at the end of the day, when carers are already tired, and broken nights soon wear people down. A house help who cooks, cleans and runs errands all day usually cannot also stay alert all night, and is not trained to handle agitation or spot early signs of infection. Children abroad often hear about a bad night only when it is already over.
This is where trained support helps. A caregiver who comes for the late afternoon and evening can take over the hours when sundowning peaks, keep the routine steady and settle your parent for bed. For parents who are awake a lot at night or at risk of wandering, live-in care means a trained caregiver is in the house around the clock, with a relief caregiver so that the main carer gets proper rest.
At Home Care Nigeria, caregivers are supervised by a named registered nurse. The caregiver writes a report after every visit, which the nurse checks and signs, covering mood, food and drink, toileting, sleep and anything unusual. The nurse reviews these reports to look for patterns, such as evenings getting worse or signs that might point to an infection, and raises an urgent alert with the family when something needs attention quickly. Families in the UK, US or Canada can read the evening and night reports from wherever they are.
If you are caring from abroad
Evening calls can be hard when your parent is at their most confused. Try calling in the morning Lagos time, when they are usually brighter. Ask whoever is with them for specific details instead of "how is she?": what time did the restlessness start, did she eat, did she sleep. Agree in advance who in Lagos will take your parent to a doctor if sudden confusion or a fever appears.
Read: caring for parents in Nigeria from abroad
If you would like to talk through evening or overnight support for your parent in Lagos, we are happy to help.
Common questions
What is sundowning?
Sundowning is increased confusion, anxiety, agitation, pacing, hallucinations or trouble sleeping that starts in the late afternoon or early evening and can carry on into the night. It happens in people living with Alzheimer's disease and other types of dementia. It is a pattern of behaviour linked to dementia and is not a disease in itself.
What are the symptoms of sundowning?
Common signs are restlessness as daylight fades, pacing, asking to go home while at home, not recognising familiar people or places, suspicion or anger, crying, seeing things that are not there, and sleeping in the day while staying awake at night.
What causes sundowning?
There is no single cause. Likely triggers include tiredness, low light and shadows, hunger or thirst, pain, needing the toilet, infections such as urinary tract infections, medicine side effects, too much noise or activity, long afternoon naps, caffeine late in the day and a body clock disturbed by dementia.
How do you stop sundowning?
You may not stop it completely, but you can often make it milder. Keep a steady daily routine, get morning daylight, limit long afternoon naps, keep tea, coffee and kola nut to the morning, turn lights on before dark, keep evenings quiet, and check for pain, hunger and toilet needs. Ask a doctor to look for physical causes such as an infection.
What is the difference between sundowning and delirium?
Sundowning builds gradually and follows a daily pattern, usually worse in the evening. Delirium is confusion that comes on suddenly over hours or days, often with an illness such as an infection, and can affect the person all day. Sudden new confusion, especially with a fever or after a fall, needs a doctor urgently.
Why is my elderly parent not sleeping at night?
Possible reasons include sundowning in dementia, pain, needing to pass urine often, breathing problems such as sleep apnoea, low mood, long daytime naps, caffeine late in the day, and medicines taken at the wrong time. A doctor should check for these, and a simple sleep diary helps.
Should I give my parent a sleeping tablet for sundowning?
Not without a doctor's advice. The Alzheimer's Association encourages non-drug approaches first. A doctor should check for physical causes and decide whether any medicine is appropriate, after weighing up the risks and benefits.
Is sundowning a sign of witchcraft or a spiritual problem?
Sundowning is part of dementia, which is a disease of the brain. Faith and prayer can be a real comfort, but a parent who becomes confused in the evenings should be assessed by a doctor so that treatable causes are not missed.
Sources
Facts checked on 3 Oct 2026. Details change, so call ahead before you go.
