Sundowning and Overnight Dementia Care at Home

Schedule a free in-home assessment · Call (760) 720-7740, available 24/7

What sundowning looks like

The Alzheimer's Association describes sundowning as increased confusion, anxiety, agitation, pacing and disorientation that starts around dusk and can continue through the night. Families tell us things like:

• "She asks to go home, even though she is home."

• "He paces, checks the doors or tries to leave after dinner."

• "Evenings bring arguments, tears or fear of shadows."

• "She's up three or four times a night, and so am I."

The exact cause isn't known. Things that may play a part include tiredness at the end of a long day, low light and shadows, a mixed-up body clock and picking up on the stress of the people around them. Sundowning often gets harder when the clocks fall back in November and it gets dark earlier.

Evening routines that may help

There's no single fix, but the Alzheimer's Association suggests steps like these, and they're the same habits our caregivers build into an evening care plan:

• Keep the day predictable: regular times for waking, meals and bed

• Plan busy things earlier: bathing, appointments and outings in the morning or early afternoon

• Get daylight: a walk or time outside during the day, when it's appropriate

• Make lunch the bigger meal and keep dinner lighter

• Turn the lights up before dusk to cut down on shadows

• Lower the noise in the evening: less TV, fewer chores and no loud music

• Use what soothes them: favorite music, photo albums, a familiar movie or a short walk

• Reassure instead of correcting. Calm words like "you're safe here" usually work better than arguing about the facts

• Let them pace safely with someone nearby, rather than trying to hold them back

• Watch for patterns and note what happens before a hard evening

When to call the doctor

Sundowning is common, but it isn't something to sort out alone. Talk with your loved one's doctor if evenings or nights suddenly get worse, if your loved one seems to be in pain, or if routine changes aren't helping. Sudden changes in confusion can have other causes that a doctor should look at. Medication timing is also a question for the doctor or pharmacist. Our care is non-medical, and our caregivers don't give medical advice.

How our caregivers help in the evening

An evening caregiver takes over at the time of day when a family caregiver is most worn out. Depending on the care plan, our caregivers:

• Keep the late afternoon calm and familiar, with quiet activities your loved one enjoys

• Prepare a light dinner and help with eating and fluids

• Give medication reminders at the times set by the doctor

• Help with the bedtime routine: toileting, washing up, changing and settling into bed

• Keep an eye on doors and gently redirect your loved one if they try to leave

• Write down what happened, so the family and the next caregiver can see what helps and what triggers a hard evening

What happens overnight

With overnight care, a caregiver is in the home through the night and ready to help when your loved one wakes up. They help with trips to the bathroom, offer reassurance when your loved one is confused or frightened, gently redirect night-time wandering and help them back to bed. A spouse or adult child can sleep through the night instead of listening for footsteps.

When nights and days both need coverage, families often move to 24-hour care, where our caregivers are scheduled in shifts around the clock. See what to expect from 24-hour dementia care at home.

Starting with evenings or a few nights

You don't have to decide on everything at once. Families often:

• Start with evening shifts that cover dinner through bedtime

• Add overnight care a few nights a week so the main caregiver can catch up on sleep

• Use respite care for a weekend or a run of nights while family is away or recovering

• Build up to 24-hour care as dementia progresses

Visits have a 4-hour minimum, and there are no long-term contracts, so you can add hours, cut back or pause care.

Why families choose Heritage for dementia care

• Our caregivers are our own employees. They're W-2 employees of Heritage Senior Care, Inc., and we hire, train, schedule and supervise them ourselves

• One written care plan for your loved one's evenings and nights that every caregiver on the schedule follows

• A consistent team: we work to keep the same small group of caregivers on the schedule, because familiar faces matter

• Family-owned since 1983: Gayle Mayben founded Heritage Senior Care in 1983 with her daughter Roni

• Licensed: a California Home Care Organization (HCO #374700058). Each caregiver completes a lifetime background check with Live Scan fingerprinting through the FBI and the California Department of Justice before caring for clients

Read more about our Alzheimer's and dementia care.

Where we provide evening and overnight care

All scheduling is handled from our one office at 2111 Palomar Airport Road in Carlsbad, and our caregivers work in homes across North County San Diego. City pages: Carlsbad, Oceanside, Encinitas, Solana Beach, Del Mar and Carmel Valley, Rancho Santa Fe, San Marcos, Escondido, Poway, Rancho Bernardo and Fallbrook.

Questions families ask about sundowning and overnight care

What is sundowning?

Sundowning is a pattern of increased confusion, anxiety, agitation, pacing and disorientation that often starts in the late afternoon or evening in people living with Alzheimer's or another dementia, and can continue into the night.

Can a caregiver stop sundowning?

No one can promise that. A calm, predictable evening routine, good lighting and a caregiver who knows your loved one may make evenings easier. If sundowning gets worse or changes suddenly, talk with your loved one's doctor.

What does an overnight caregiver do?

A caregiver is in the home through the night and helps when your loved one wakes up: trips to the bathroom, reassurance, gently redirecting wandering and helping them back to bed, so family members can sleep.

Can we get help just for evenings?

Yes. Many families start with an evening shift from dinner through bedtime. Visits have a 4-hour minimum, and you can add overnight or 24-hour care later.

Do your caregivers give medication for agitation or sleep?

No. Our caregivers give medication reminders. They do not administer medication or provide medical or nursing care. Questions about medication belong with your loved one's doctor.

Are your caregivers trained in dementia care?

Our caregivers are W-2 employees of Heritage Senior Care, Inc. We train, schedule and supervise them ourselves, and every caregiver follows a written care plan built around your loved one's routines and what calms them.

My parent gets worse after the time change. Is that normal?

Many families notice harder evenings when the clocks fall back and it gets dark earlier. The Alzheimer's Association suggests keeping routines steady, getting daylight and keeping the home well lit as evenings get shorter.

What happens during the free assessment?

We meet you and your loved one at home, talk through what evenings and nights look like, walk through the house for safety and discuss how many hours of help you need. Then we put together a care plan. Call (760) 720-7740, available 24/7, or request a free assessment. You can also send us a note.

Calmer evenings and full nights of sleep, with care from a family that has been doing this since 1983. Free assessment · (760) 720-7740 (24/7) · Office Mon–Fri 9 am–4 pm · 2111 Palomar Airport Rd Ste 120, Carlsbad, CA 92011