Indal

I noticed that when i wait during the day or a bit before the sun rises. My hypothesis is that the game is struggling to load the Shadows that are casted while also trying to switch to their proper positions to match the hour of the day? Do you feel that "Choke" during night waiting time or indoors as well?

No you are not an idiot,relax. I also have this problem when refilling my HP with other things except stimpaks like melons,tatos,Rad Meat etc. I almost always get out of pip boy and watch my health bar be one tick to full and it drives me crazy. Wait for the glorious Creation Kit

I dont get it.Your settings are fine Do you have your ini files set as read only? If yes,try disabling that and then run with NMM as administrator

Have you installed any Texture mods that might not got uninstalled even with NMM? I had this issue when i experimented with some retexture mods and the result was irreversible so i had to reinstall the game. Edit: Nevermind just saw that you verified your cache.

Too many lights at the same time.At least thats what it looks like to me.

Can you please post your entire Fallout4prefs.ini and Fallout4.ini? I wanna take a look at them.

It looks like your save is corrupted. I dont know if there is any solution for this except loading a previous save that works and continue from there. Also Do Manual save a lot instead of Quicksaving,it helps you keep track of corrupted saves easier.