Thank you for asking such an important question. It is important as many people have this problem. Rumination means that a person keeps thinking about a problem, a situation or a scenario over and over again, just like the way the cow would chew its food repeatedly.
In my clinical practice, I treat many patients with insomnia problem and one perpetuating factor for insomnia is the propensity to ruminate. These persons go to bed and their minds will start to wander. For instance, they would think about the events that happened in the daytime and what would happen the next day. They would also think about their future and all the possible scenarios that may go wrong. They tend to think about the issues over and over again, and hence the term 'rumination'. As a result of the ruminations, their mind becomes more active and hence they cannot fall asleep.
Ruminations are commonly reported in patients with anxiety and depressive disorders. They are also found in patients with obsessive compulsive disorder.
Treatment largely depends on the underlying diagnosis and other associated clinical features. Medications like SSRIs may diminish ruminations. I also teach my patients to put aside time in the daytime to do all these thinking and mental processing so that they will not think about the issues at night. Many patients find these suggestions useful as evidenced by their relative ease in negotiating the transition between wakefulness and sleep when they go to bed at night.
