If someone you care for has Alzheimer’s disease or another form of dementia, you have probably seen them experience sundowning, especially if they have a more advanced stage.

Also known as late-day confusion, sundowning can cause their confusion or agitation to get worse in the late afternoon or evening compared to earlier in the day. This can be scary for them and for you to experience.

The exact causes of sundowning aren’t fully understood, so it may not be possible to fully prevent it. But there are things you can do to reduce it. Here are some steps you can try.

Dementia can make it hard to develop and remember new routines. Your loved one might react to unfamiliar places and things with feelings of stress, confusion, and anger. These feelings can play a large role in sundowning.

In fact, 2019 research suggests that lack of routine can also lead to depressive symptoms in all older adults.

So instead, try to help them build and stick to a regular routine every day. For example, if they get up, bathe, eat, and go to bed at the same time every day, it will help them be calmer and minimize opportunities for confusion.

If you need to make changes to their schedule for some reason, try to do so as gradually as possible.

Since sundowning usually happens in the afternoon or evening, try to schedule any doctors’ appointments, trips, or other stimulating activities for the mornings. That’s when your loved one will be at their clearest, so they’ll be less likely to get confused.

Try to help your loved one stay calm in the evening hours. Encourage them to stick to simple activities that aren’t too challenging or frightening. Frustration and stress can add to their confusion and irritability.

For example, try to avoid noisy groups and loud noises if possible, as well as doing any chores that might be overwhelming for them. Older adults are more sensitive to noise, according to a 2018 study.

If they have mid-stage or advanced dementia, watching television or reading a book might be too difficult for them in the evening. Instead, consider playing soft music to create a calm and quiet environment. Some people also enjoy looking at photographs. It might also be a nice time for them to snuggle with a beloved cat or other pet.

Your loved one might experience sundowning as the result of changes in their circadian rhythm, which is their sleep-wake cycle.

That’s why adjusting the light in their home might help reduce their symptoms. For example, a 2011 research review found that light therapy can help reduce agitation and confusion in people with dementia.

So consider placing a full-spectrum fluorescent light about 3 feet (1 meter) away from your loved one for a couple of hours each morning.

Many people who experience sundowning have trouble sleeping at night. In turn, fatigue is a common trigger of sundowning. This can create a vicious cycle.

Too much daytime dozing and inactivity can make it harder for your loved one to fall asleep at bedtime. To promote a good night’s sleep, help them stay active during the day.

For example, consider going for a walk in the park together. This will help reduce their restlessness, give them natural sunlight exposure and fresh air, and might improve their sleep quality. All of this may reduce their sundowning symptoms. Plus, it can also help them enjoy better physical health.

According to the Alzheimer’s Association, it’s important to adjust your loved one’s eating patterns with dementia. This may also help reduce their sundowning symptoms.

For example, large meals at night can increase their agitation and may keep them awake. Instead, encourage them to have a larger meal at lunch and a lighter one in the evening. That will help them feel more comfortable and rest easier at night.

All three of these substances can increase their restlessness and irritability, and affect their ability to sleep. So try to encourage them to avoid those substances altogether, if possible — or at the very least, avoid them in the evenings.

Think back to the last time you were sick. Chances are, you wanted to be surrounded by comforting thoughts, things, and people. For someone with dementia, the world can become a scary place. Comfort and familiarity can help them cope with this difficult time in life.

Help fill your loved one’s life and home with things they find comforting. If they move into a hospital or assisted living facility, furnish the space around them with cherished items. For example, bring their favorite blanket or family photos to the new facility. This may help ease the transition and curb some of their sundowning symptoms.

Make sure that your loved one has safe and comforting sleeping arrangements. This might mean that they prefer to sleep in a different bed or bedroom that feels safe or familiar. You might also want to change their sheets or blankets to ones they like and feel comfortable sleeping on.

In addition, it can be helpful to add night lights to their bedroom, as well as the bathroom and hallway, in case they get up in the middle of the night. This will help them see and hopefully minimize confusion.

Sometimes, sundowning occurs when your loved one has a need, but they’re struggling to communicate what they need because they’re confused. So if you see your loved one getting agitated, consider that they might be hungry, have low blood sugar, need to go to the bathroom, or be in pain.

Once you figure out what’s wrong, you can help them address that need — and it might help them calm down a little easier.

If you can’t find an obvious cause, you might also be able to help calm them down by distracting them. For example, consider talking to them about a favorite memory or a topic they like thinking about.

Each person has different triggers for sundowning. To help identify your loved one’s triggers, use a journal or smartphone app to track their daily activities, environments, and behaviors. Look for patterns to learn which activities or environments seem to make their symptoms worse.

Once you know their triggers, it will be easier to avoid situations that promote agitation and confusion.

Melatonin is a gentle, natural food supplement. It can help anyone fall and stay asleep, but a 2014 review found that it could help reduce agitation at night and improve sleep in people with dementia.

Even though it’s available over the counter, be sure to chat with your loved one’s doctor before giving them melatonin. A doctor can make sure it’s advisable for their needs.

Some prescribed medications may come with side effects that trigger sundowning, especially if they’re taken in the late afternoon or evening.

So if you are noticing that your loved one is experiencing sundowning regularly, check in with their doctor and ask them when it’s best to take their medications to reduce possible triggers.

Sundowning can be exhausting for both you and your loved one. As a caregiver, it’s essential to take good care of yourself by practicing self-care. You’ll be in a better position to give your loved one the patience and support they need when you’re rested and healthy.

Try to eat a well balanced diet, exercise regularly, and get enough sleep at night. Ask other family members or friends to spend time with your loved one, so you can enjoy regular breaks. You can also ask your doctor about respite care and other professional support services, which can help you take time out from your caregiving duties.