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Moreover, although daily diary and experimental studies among civilians have found negative associations between alcohol use and sleep, these patterns change with consecutive days of drinking and may differ for those with insomnia. This study measured (a) acute and cumulative day\u2010level associations between sleep and alcohol use among heavy\u2010drinking US veterans and (b) the extent to which insomnia moderates these associations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Self\u2010reported ambulatory assessments occurring daily for 14\u2009days.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>USA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>Heavy\u2010drinking veterans (<jats:italic>n<\/jats:italic>\u2009=\u2009118, 84% male, 79% White, <jats:italic>M<\/jats:italic>\u2009=\u200939y) with sleep complaints. Seventy\u2010one met criteria for insomnia disorder.<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements<\/jats:title><jats:p>Participants completed a semi\u2010structured clinical interview and baseline self\u2010report measures, followed by 14 consecutive days of morning sleep diaries. Data were analyzed using multilevel models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>Insomnia moderated day\u2010level associations between alcohol use and sleep. Heavier drinking was associated with worse same\u2010night sleep quality among those without insomnia [<jats:italic>b<\/jats:italic>\u2009=\u2009\u22120.06; 95% confidence interval (CI) = \u22120.09, \u22120.03], but this pattern was not statistically significant among those with insomnia (<jats:italic>b<\/jats:italic>\u2009=\u20090.02; 95% CI = \u22120.01, 0.04). Similarly, more consecutive nights of poor sleep efficiency were linked to lower drinking quantity among those without insomnia [incidence rate ratio (<jats:italic>IRR<\/jats:italic>)\u2009=\u20090.91; 95% CI = 0.83, 1.00), while better sleep efficiency was linked to heavier next\u2010day drinking among those with insomnia (<jats:italic>IRR<\/jats:italic>\u2009=\u20091.01; 95% CI = 1.00, 1.01). More consecutive nights of drinking were linked to shorter sleep duration, regardless of insomnia status (<jats:italic>b<\/jats:italic>\u2009=\u2009\u22120.09; 95% CI = \u22120.18, \u22120.002).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>US military veterans with insomnia do not appear to experience the same negative day\u2010level associations between alcohol use and sleep that those without insomnia report.\u00a0However, over time, drinking is linked to worse sleep in both groups.<\/jats:p><\/jats:sec>","DOI":"10.1111\/add.16770","type":"journal-article","created":{"date-parts":[[2025,1,18]],"date-time":"2025-01-18T11:04:08Z","timestamp":1737198248000},"page":"895-904","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Daily associations between sleep and alcohol use among veterans: Acute and cumulative 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USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1491-7771","authenticated-orcid":false,"given":"Brian","family":"Borsari","sequence":"additional","affiliation":[{"name":"Mental Health Service (116B)  San Francisco CA USA"},{"name":"University of California San Francisco  San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce D.","family":"Bartholow","sequence":"additional","affiliation":[{"name":"University of Iowa  Iowa City IA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"Steinley","sequence":"additional","affiliation":[{"name":"University of Missouri  Columbia MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina S.","family":"McCrae","sequence":"additional","affiliation":[{"name":"University of South Florida College of Nursing  Tampa FL 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