I'm curious if anyone else has noticed this effect. I had bulbar onset a few months ago but haven't had much progression. My speech is a little worse sometimes. What I've noticed is that if I am in a situation where I am nervous or tense, my speech actually gets better. This happens a lot at the doctor's office, or really any time I'm around strangers (I'm not too sociable). But when I am at home and just talking to my wife, very relaxed and comfortable, my speech gets worse, much more slurred, and I often have difficulty getting words out. When I'm tense it's like I have more energy to direct to my speech muscles.