OK - what I would do - first off the 4GB patch was included a while back in an official update, I'm pretty sure it's no longer needed
- second if you're having problems with sound, try removing the sound mods (specifically the additional music system and personalised music, I use the others myself so I don't think it's those files).
- third - use BOSS, it sorts your mod list into the correct order, I've been told it works for skyrim even though it was designed for oblivion.
- fourth DRIVERS.. make sure they are up to date (obvious I know)
- finally you may just have to lump it and uninstall mods one by one until the problem disappears, it is more likely to be mods than the vanilla game - if it is the vanilla game reinstall.. If it is a mod, make sure the files are packed correctly for NMM to install and follow the instructions.. All the advice I can give ya atm
I have at least 3 times as many mods as this and my game runs perfectly; I'm probably lucky (but I do read all readme's and have been modding stuff for years)
I'd like to add a few things to ^aboves^ very thorough reply. Though I do agree that the sound mods are most likely what's causing the problem, it's not necessarily always the sound mods, lots of times it's just strange conflicts between mods and other mods or vanilla games that the modders never intended or just went unnoticed. So yes I'd certainly try uninstalling (or unloading) the sound mods first off and FOR SURE unload the Unnoficial Patch, it's unofficial for a reason and conflicts with alot of things (as that is kinda it's purpose). If none of that works then try decreasing the amount of HD and graphics mods in there, you have a hell of a lot and it can get unstable past a certain amount from my exp.
EDIT: One more thing I forgot, delete your configuration files completely from 'My Documents/My Games/Skyrim/' and let the launcher reset graphics and config files back to Ultra or whatever you like to run it on.