Stuck in his rut...again.

We have been married almost 20 years and have three teenagers. I love my husband very much.  Even though we've both always had to work (isn't that mostly everyone today?), he's always done his part with work and contributing to the expenses (usually more than me). He was very much unlike my Dad and was very quiet and humble, I suppose that's part of what I found attractive.  

I work full time overnights, my husband works primarily from home, occasionally going out to meet with clients.   His work is done on the phone and laptop, the latter of which is next to bed.  Did I mention I work at night?  While he is normally pretty quiet, this is a huge sticky point for me as it comes across as a lack of respect.  I need to sleep well to be up all night for work. I have occasionally slept in one of the kids rooms during the day.  Once in a while he'll ask me where I plan on sleeping (which I take as a subtle way of him asking me to sleep elsewhere). I don't think it should be considered that much of a sacrifice for him to work somewhere else in the house.  Why is this such a big deal?  On to related point two.,....

He is in our bed with the laptop ALL THE TIME.  He works in bed, he surfs the internet in bed, he eats 95% of meals IN BED, with the laptop on his chest.  

Low testosterone, really low is happening now, he is no longer taking supplements for that.  Showering is back to every three or four days (unless he has to go out for work which isn't generally more than once a week).  The argument?  Well, he's in bed most of the time and "doesn't get dirty".  If there is no interest in or possibility of sex, why take a shower?  So, not only is there very little sex, but very little affection of any kind, and if he hasn't showered in three days, I'm hesitant to put my arms around him.  That's an issue he can certainly control.   Our affection is mostly a kiss when I leave for work or when he goes out.  

His stress level with work is high, always has been.  He is on one anti-depressant/anti-anxiety and he has a once a day prescription for Ambien, which when he refills it, will take the entire bottle over 8-10 days rather than 30 days.  When he's out of Ambien, he takes over the counter sleeping pills to help him "relax". This is a huge no-no and I am concerned he's really screwing with his system.  I suggested I go with him to his next doctors appointment and he said he would be fine with that.

I feel like a parent nagging a child.  If anyone has any similar situations, I'd love to hear what you did to help remedy things or push your spouse along to perk up.