Dear Jen

Thanks for your question.

Rumination in bed that prevents sleep is quite common and you are right to identify that rumination starts as soon as you lie down in bed and try to go to sleep. We find that this is one of the worst times for rumination for many people as it is a time when there are few distractions and a tendency to review the day.

From what you say, it sounds like rumination has become an automatic habit that is triggered by going to bed and by the cues of your bedroom. It then makes it hard for you to sleep fuelling your exhaustion. I can sympathise as to how this must be very difficult for you.

There are several approaches that may be helpful to change this habit.

First, it is useful to try and break the link between rumination and being in bed trying to sleep. This means not spending time lying in bed when ruminating. One step is to do relaxing and calming activities in the hours before going to bed to reduce the likelihood of ruminating. It is helpful to reduce your mental and physical arousal as much as possible as these both feed into rumination. So it is a good idea to not work late or engage in difficult activities before going to bed.

Another step is to only go to bed when feeling sleepy so that you quickly fall asleep. Some people find it helpful to read a pleasantly engaging book in bed, listen to relaxing music or stories or to practice relaxation exercises.

Critically, if you can't get too sleep and your mind starts whirring around, you need to get out of bed, and ideally leave the bedroom and go and do something else calming until you feel sleepy again. At this point, you return to bed and hopefully fall asleep again quickly, say within 15-20 minutes. If you don't, you get up again and go out again and do something else to distract yourself until you feel sleepy again and so on. You repeat this cycle until you fall asleep quickly on getting into bed. This approach can take a few goes to start to work and does at first feel counterintuitive as you are sleeping less and getting up when you feel tired. However, the idea is to break the mental link between getting into bed and starting to ruminate by minimising the time you spend in bed whilst ruminating. Instead, you are hopefully building a link between getting into bed and falling asleep, which as it strengthens over a number of nights, will make it increasingly easy to fall asleep.

A third step is to consider what it is you tend to ruminate about and how to tackle this in the day and evening before you go to bed. For example, some people find themselves reviewing how the day went and what they face the next day, and these post mortems and planning can quickly spiral into rumination, keeping them awake. If this is what influences you, to avoid this affecting your sleep, it can be helpful to set aside a time earlier in the day, to review these thoughts so you don't have to do it at night. Some people find it helpful to have a pad and paper so they can quickly note down what they need to think about another time, so they put it aside at night. Others find it helpful to try and focus on problem-solving rather than rumination - instead of asking Why? and what does this mean?, it is helpful to ask "How did this happen?" and "What can I do about it?"

Other people find that their rumination involves rerunning in their mind past events that were difficult or upsetting or hard to come to terms with. Whilst they can keep these memories at bay during the day, they pop back at night when their imaginations are able to roam a bit freer. In these circumstances, it can be useful to try and work through the upsetting memory, during a safe time during the day, and to do this on repeated occasions, so that it is likely to pop up again at night.

I hope these suggestions are useful.

All the best

Ed Watkins