Objective: Insomnia and heavy alcohol use are common in Veterans with PTSD, and associated with cognitive impairment. However, the interactive effects of insomnia and heavy alcohol use on cognitive function in Veterans with PTSD have not been previously reported. Method: We assessed baseline insomnia (Insomnia Severity Index), amount of alcohol use (standard drinks per week [DPW]), and frequency of heavy drinking days (HDD) in 63 heavy drinking Veterans with PTSD enrolling in a RCT of topiramate treatment. We used random-intercept linear mixed models to investigate the interaction of insomnia and alcohol use on the following cognitive domains: processing speed, working memory, auditory-verbal learning and recall, cognitive flexibility, response inhibition, motor inhibition, choice inhibition, risk-taking, and decision-making. Results: Significant HDD-by-insomnia (F(1,22) = 4.32, p = 0.05) and DPW-by-insomnia (F(1,57) = 5.88, p = 0.02) interactions were observed for processing speed and a DPW-by-insomnia interaction for auditory-verbal recall (F(1,58) = 7.35, p...

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