Cortisol shows a well-documented circadian rhythm with peak levels observed shortly after awakening and steadily decreasing values thereafter. This is a relatively robust diurnal pattern that is displayed by most non-ill individuals, but recently it has been shown that in the general population some 10-15 per cent of individuals have 'flat' circadian cycles of cortisol. We have analyzed post-awakening variations in levels of salivary cortisol in veterans without post-traumatic stress disorder (PTSD), veterans with diagnosed PTSD that were not hospitalized, and hospitalized veterans with PTSD. 'Flat' circadian cycles of salivary cortisol were observed in 6 per cent of veterans without PTSD, 29 per cent of non-hospitalized veterans with PTSD, and 42 per cent of veterans hospitalized for PTSD. Copyright (C) 2004 John Wiley Sons, Ltd.