The day winds down, and you’re hoping for a moment of peace. The dishes are done, the lights are dim, and everything should feel calm. But instead, your loved one with dementia becomes uneasy. They’re pacing, asking the same questions over and over, maybe even growing frustrated or fearful. It feels like someone has flipped a switch—and it happens almost like clockwork.

This isn’t your imagination. It’s a common experience in dementia, known as sundowning. While the reasons behind it can be complex, one often-overlooked factor might be sitting quietly in the medicine cabinet: their medications.

What Is Sundowning?

Sundowning describes a pattern of behavior where a person with dementia becomes more confused, anxious, or agitated in the late afternoon or evening. It’s not unusual for a relatively calm day to suddenly turn unpredictable and exhausting.

There are several possible causes—changes in light, overstimulation, fatigue—but many people don’t realize that certain medications can make these symptoms worse.

How Medications Can Contribute

Some medications that are routinely prescribed to older adults can actually increase confusion or restlessness—especially in the evening hours. A few common culprits include:

• Anticholinergics – Found in medications for sleep, allergies, or incontinence, these can interfere with thinking and memory.
• Benzodiazepines – Like Xanax or Ativan, these are used for anxiety or sleep but can lead to agitation or increased disorientation.
• Certain antidepressants and antipsychotics – These may worsen restlessness or cause unintended side effects in those with dementia.
• OTC sleep aids – Even seemingly harmless over-the-counter medications can trigger cognitive changes, particularly as the body begins to wind down.

While these medications may be helpful in some ways, their side effects in people with dementia can be subtle—and can emerge most strongly as the day comes to a close.

What You Can Do

If your family member’s evening behaviors have changed, or if sundowning has gotten worse over time, take a closer look at their medication routine.

Bring a complete list of all prescriptions, supplements, and over-the-counter remedies to their next doctor’s appointment. Ask if any of them might be contributing to what you’re seeing. Sometimes the solution is as simple as changing the dose or adjusting the time it’s taken.

You Don’t Have to Handle It Alone

Sundowning can take a serious emotional toll—not just on the person with dementia, but on you as the caregiver. You're doing your best, but evenings can feel never-ending when you're worn thin.

That’s where specialized in-home dementia care can make a difference.

Traditions Home Health Services Is Here to Support You

At Traditions Home Health Services, we provide specialized dementia care in Boston, Metro West, South Coast, and the surrounding areas in Eastern Massachusetts, with live-in care services available throughout New Hampshire, Vermont, Maine, and Massachusetts. Our experienced caregivers are trained to recognize sundowning patterns and know how to respond with calm, patience, and empathy.

From monitoring medication side effects to creating peaceful evening routines—or even staying overnight—we’re here to help.

Want to learn how home care can ease the stress of sundowning? Call 617-376-3711 to schedule your free in-home consultation.