Sundowning and Hallucinations

Responding to What Isn’t Real

As evening approaches and the light dims, your mother may suddenly become upset. She might insist there are children playing in her bedroom. Even if you see nothing, those children seem completely real to her. She may even hear them laughing.

This is one of the most challenging aspects of sundowning: the hallucinations and delusions that frequently accompany the confusion and agitation as evening approaches. While we’ve previously explored general strategies for managing sundowning, understanding how to respond specifically to hallucinations requires a different set of skills and approaches.

When Reality Shifts at Sunset

Hallucinations are among the more distressing symptoms that can occur during sundowning episodes. Your parent might see people who aren’t there, hear voices or music that doesn’t exist, or even smell things that have no source. These experiences feel completely real to them, no matter how impossible they seem to you.

Visual hallucinations are the most common type in dementia-related sundowning. Your father might see strangers in the house, small animals scurrying across the floor, or patterns in the wallpaper that transform into faces as the light changes. Auditory hallucinations—hearing voices, music, or other sounds—also frequently occur during late afternoon and evening hours.

The timing isn’t coincidental. As natural light fades, shadows widen, and familiar objects can appear distorted or unfamiliar. The brain of someone with dementia already struggles to handle sensory information accurately. Add failing light, fatigue from a full day, and the disturbed circadian rhythms common in dementia, and you have a perfect storm for perceptual confusion.

Why Arguing Never Works

When your mother insists she sees children in her room, your first instinct might be to correct her. “Mom, there’s no one there. You’re just seeing things.” This approach, though understandable, almost always makes the situation worse.

It’s important to remember that for someone having a hallucination, what they see or hear feels real. Their brain is making these images or sounds, and logic will not make them go away. Telling them it’s not real can make them feel they can’t trust their own senses—or you.

This can lead to several problematic outcomes. Your parent may become more agitated, insisting that you’re lying or trying to gaslight them. They might feel frightened that you can’t see what they see, wondering what’s wrong with you or the situation. Or they may simply stop sharing what they’re experiencing, leaving you unable to help or provide comfort.

The Power of Validation

Instead of arguing about reality, concentrate on validating feelings. This doesn’t mean you have to pretend to see what they see. It means acknowledging the emotional experience they’re having.

If your father says he sees a strange man standing in the hallway and seems frightened, respond to the fear, not the hallucination. You might say, “That sounds scary. I can see you’re worried. You’re safe here with me, and I’m going to make sure you stay safe.”

This approach accomplishes several things simultaneously. You’ve acknowledged their experience without confirming the hallucination exists, addressed their emotional state directly, and provided reassurance about their safety.

When the hallucination seems pleasant or neutral—perhaps your mother mentions seeing her own mother sitting in a chair—you don’t necessarily need to intervene at all. If it’s not causing distress, it may be providing comfort. Simply acknowledge it: “It’s nice that you feel your mother’s presence.”

Practical Response Strategies

When a hallucination does cause distress or fear, having a toolkit of responses can help you cope with these difficult moments.

• Stay Calm and Assess – Your emotional state directly influences theirs. Take a breath. Speak in a gentle, soothing tone. Assess whether the hallucination is actually causing a problem or whether your own discomfort is the real issue. Not every hallucination requires intervention.
• Check for Triggers – Look around the environment. Is there low lighting creating shadows? Are patterns on curtains or wallpaper creating visual confusion? Is a television on, creating sounds that might be misinterpreted? Sometimes addressing the environmental trigger can help the hallucination fade.
• Gentle Redirection – Once you’ve validated their feelings, you can try gently redirecting their attention. “I know you’re seeing something that worries you. Come with me to the kitchen—let’s have some tea and sit where it’s brighter.” The combination of movement, change of environment, and a simple, comforting activity can help shift their focus.
• Use Touch Thoughtfully – A light hand on the arm, a soft pat on the back, or holding their hand can be grounding. Physical touch reminds them of your presence and can help bring their attention back to the here and now. However, be attentive to their response—some people find touch comforting during hallucinations, while others may find it overwhelming.
• Honest Without Argument – If they directly ask you whether you see what they see, you can be honest without being argumentative. “I know you’re seeing something, but I don’t see it. What does it look like to you?” This validates their experience while being truthful about yours.

When to Seek Medical Attention

Hallucinations during sundowning are common, but certain situations may warrant contacting a doctor. If hallucinations are new, have suddenly worsened, or are accompanied by other concerning symptoms, medical evaluation is important.

Urinary tract infections, medication interactions, dehydration, and other treatable medical conditions can cause or worsen hallucinations. Pain that someone with dementia can’t adequately communicate might also appear as increased agitation and perceptual disturbances.

If hallucinations bring about dangerous behaviors—attempting to leave the house at night, aggressive actions toward perceived threats, or extreme agitation that you can’t calm—professional medical intervention may be needed. Your parent’s doctor might modify medications, recommend different management strategies, or detect underlying medical concerns contributing to the problem.

The Caregiver’s Challenge

Watching someone you love experience hallucinations is emotionally exhausting. You’re caught between wanting to fix the problem and knowing you can’t simply make it go away. You feel helpless when they’re frightened by things you can’t see.

It’s particularly difficult during sundowning because these episodes happen when you’re likely already tired from the day. The hours between late afternoon and bedtime can appear endless when you’re managing confusion, agitation, and hallucinations.

This is where professional in-home care can have a significant impact. Trained caregivers understand dementia-related behaviors and know how to respond calmly and effectively to hallucinations. They can manage the challenging sundowning hours while you take a break or focus on being family rather than functioning as a full-time caregiver.

Professional caregivers also bring consistency to the evening routine, which can reduce the rate and severity of sundowning symptoms. When the same caregiver arrives each evening at the same time, following familiar routines in familiar ways, it creates structure that helps reduce confusion and agitation.

Finding Your Approach

Every person with dementia experiences sundowning differently, and what works one evening might not work the next. You’ll develop a feel for your parent’s patterns—certain triggers, responses that help, times when intervention is needed versus when it’s better to let a harmless hallucination run its course.

Keep notes about what you observe. Does your mother see the same hallucination repeatedly? Does it happen at the same time each evening or in the same location? Are there patterns related to activities, meals, or medications? These observations can help you identify strategies to prevent or minimize distressing episodes.

Remember that the goal isn’t to eliminate all hallucinations—that’s often not possible with current treatments. The goal is to reduce distress, maintain safety, and preserve quality of life and your relationship during a difficult stage of dementia.

Your parent doesn’t choose to have these experiences, and they’re not trying to be difficult. Their brain is processing information in ways they can’t control. What they need from you isn’t correction or logic—it’s patience, comfort, and the reassurance that even when their reality feels frightening or confusing, they’re not alone.