The Evening Gets Loud: How to Tell Sundowning Has Started Before the Night Is Lost

Most evenings do not go bad all at once. They start to go bad around the same hour, and the first sign is small: she asks where her mother is, she starts folding the same towel, or she wants to go home while you are standing in the kitchen. If you have been running the day from memory, that hour will catch you tired, and you may not connect it to anything. Writing it down is how you connect it. This pattern is often called sundowning, and it can look different from one woman to the next.

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Find the hour, not the mood

On the day sheet, put a small mark at the hour the change first shows up. Do not write how bad it was. Write what time it started and what was happening just before. Keep this up for a week. The change often lands at about the same time each day, and that fixed hour is the thing you can plan around.

Write down what came before

For each episode, look back at the half hour before it started and check four things. Write one line for each:

• Light: did the room get dim before she became restless?
• Body: was she hungry, thirsty, tired, too warm or too cold, or sitting too long?
• Bladder and pain: had she been to the bathroom recently, and is anything hurting her?
• People and noise: did a visitor leave, did the television or phone go on, did the house get busy?

After a week, read back the lines. You are looking for the one or two things that show up before most of the episodes. Those are the things you change first.

Change the room before you change her

Once you see the pattern, the first moves are usually in the house. Turn the lights on before the window goes dark. Close the blinds at the same time each evening. Have a snack and a drink ready at a set hour. Lower the television and keep the noise down. Keep these the same every evening so the house tells her what comes next. Write each step on the sheet so that whoever is in the house at that hour does it the same way.

Hand off the hard stretch by name

Put the difficult hours on the sheet as a handoff. Name the person who takes them, the hour they arrive, and what they do: sit with her, walk the hall with her, run the same show she likes. A hired non-medical caregiver can keep her company, offer a drink and a snack, and do the same routine you do. Medicine stays with the family, her doctor and the pharmacist, so write that on the sheet too, so no one has to guess at it during the hard hour.

Take the record to her doctor

Bring the sheet to her next visit. Bring the usual hour, the four things you checked before each episode, and what seemed to help. If the evening change comes on quickly, over days rather than over weeks, or if she seems suddenly unlike herself in a way that does not settle, do not wait for the next appointment. Call her doctor the same day and tell them what you have written down.

If you need someone to sit with her in the evening, the Local Help for Husband Caregivers page is a place to start looking.