Baby boomers have long dominated the marketplace, whether they craved hula hoops, vinyl records or McMansions. Now the baby boomer engine is revving up and ready to drive the sleep disorders field toward unprecedented growth for decades to come.

With the oldest baby boomers turning 60 this year, many are grappling with sleep troubles that affect their physical health, emotional well-being, cognitive ability and job performance. Close to half of all adults over 50 get fewer than 7 hours of sleep per night, and 25% believe they have a sleep disorder, reported a Gallup survey released in November 2006 by the International Longevity Center-USA.

"Baby boomers are right on the cusp of sleep medicine," says Paul Selecky, MD, medical director of the pulmonary department and sleep disorders center at Hoag Memorial Hospital in Newport Beach, Calif. "Sixty-year-olds to 70-year-olds make up the bulk of our practice."

Difficulty Falling and Staying Asleep
It's a common misconception that older people need less sleep. Most people require 7 to 9 hours of sleep throughout adulthood. Yet as people age, changes in sleep architecture, physiology, lifestyle and medical conditions can make enjoying a restful sleep more elusive.

For example, a study cited by the National Sleep Foundation reported that after age 65, 13% of men and 36% of women took more than 30 minutes to fall asleep. Several reasons explain why.

Every age group has its share of stress, but many boomers find themselves sandwiched between caring for fragile elderly parents at one end and hormonally agitated teenagers at the other. Throw in a mortgage, college loans and a pressure-filled job with numerous responsibilities, and that's a lot to try to not think about at bedtime.

And chronic illnesses such as arthritis, diabetes and hypertension start to manifest in late middle age. The discomfort of these conditions and the medications prescribed to relieve them can wreak havoc with sleep.

"We now understand that if you have a chronic medical condition associated with insomnia, even when you effectively treat the condition, the insomnia complaint may persist and may require independent treatment," says Patrick Strollo, MD, director of the University of Pittsburgh Sleep Medicine Center. "The notion in the past was treat the condition and sleep will improve."

It's also common for older people to have more difficulty maintaining sleep than in their younger years, Strollo says. Baby boomers he treats often report troublesome 3 a.m. awakenings.

"From a biological standpoint, over time there is a loss of nocturnal secretion of growth hormone associated with deeper stages of sleep," Strollo says. "This happens as women approach menopause, too. This loss may trigger an insomnia complaint and perpetuate it."

Restless legs syndrome or periodic limb movement disorder also can hijack older adults' sleep. These neurologic disorders are more prevalent in the elderly and cause them difficulty in falling and staying asleep. A central dopamine mechanism is likely involved with these conditions.

Apnea and Aging
Of all sleep disorders, obstructive sleep apnea remains the most common among baby boomers. The National Institutes of Health's Sleep Heart Health Study found that "the prevalence of apnea increases up to age 65 then levels off," Strollo says.

In middle-aged men and women (ages 30 to 60 years), the prevalence of sleep-disordered breathing is 4% to 9%; in older adults (over 60 years) it's 45% to 62%.

Part of the reason is that as people age, their bodies don't shed weight as easily as the bodies of 20-somethings. Obesity and its associated risk for hypertension and OSA increase in midlife.

"Many patients come here because their blood pressure is creeping up, and they're gaining weight," says Mark Pressman, PhD, director of sleep medicine services at Lankenau Hospital in Wynnewood, Pa.

Surprisingly, though, some epidemiologic data suggest that patients under age 55 who are identified with apnea may be at greater risk for cardiac complications such as hypertension, atherosclerosis, heart failure and stroke than older patients.

"It appears younger patients tend to be slightly more vulnerable," he says. "This may reflect increased severity at a younger age. This generation is much more obese than the baby boomer generation on average. Down the line, it may be that obesity will be an important concomitant risk factor in this generation."

At Lankenau Hospital, 90% of patients who come in the door will have OSA, Pressman says. "It may vary in presentation and complaint, although the No. 1 complaint is 'I'm tired, I doze off during the day, I feel worn out.' Men are often dragged in by family members because of their loud, obnoxious snoring. Unless they wake themselves up, loud snorers are the last to know they are ripping the paint off the walls."

However, many boomer-aged women like Mary Ellen Thomas, 55, trumpet at night just as loudly. With her three children grown and independent, Thomas enjoys life as an empty nester immensely. Her waking life, that is. Her sleeping life, well, that has known a few speed bumps.

Thomas decided to have a sleep test in 1999 as a birthday present for her second husband, a light sleeper continually awakened by her snoring. The Bryn Mawr, Pa., native was "floored" to learn she had 150 arousals during that night in the lab. Her oxygen saturation dropped to a concerning 70%.