I think I may have figured out what the issue is or at least part of it. During the October creator update, there were a lot of issues with the Windows memory standby list causing issues with games. I never had an issue with that update personally, but it seems like it’s rearing its ugly head with the 1903 update for me. Using RAMMAP I noticed my standby memory usage was through the roof. Upon clearing it periodically via a script I wrote, it seems to have fixed the issue, at least so far.