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Extreme fatigue in 81 year old male

I need advice on how to help my dad who is 81. He is BEYOND TIERD ALL THE TIME. He has had severe sleep apnea for almost 20 years. He's done many sleep studies, not recently though. He is on the max pressure that a CPAP can do as well as has an oxygen generating machine that he connects to the CPAP. He is probably 60 pounds overweight (5'6" 220 lbs) but has lost almost 40 pounds in the last two years (trying to be healthier). He's had high blood pressure for 30+ years and is on medication for it. He is prediabetic, but most recently his A1C was 5.1, so he is not medicated and that condition seems relatively stable. He goes to the gym 4 times a week and does weights and machines. Last fall he started getting breathless from even the slightest exertion (like getting into the car). He went to the pulmonologist who said his lungs are fine. He had a heart catheterization done about two years ago, and they said he had about 25% blockage but did not need a stent (he had this done when he was around 50 also and was told the same thing, so his blockage has been the same). He went to the cardiologist last fall also (after the pulmonologist to try and get at the source of the breathlessness) and they did an echocardiogram. The results of the echocardiogram were that he has mitral and aortic valve regurgitation. But, he was told that the valve regurgitation is trivial. He wakes up tired every day. He hasn't felt rested for even 5 minutes for years. He does have a "speed" type drug to help with alertness but he doesn't like to take it and rarely uses it. He takes naps all the time. A typical day is he tries to get up around 9 but stays in bed until 11:30. He gets up, has lunch, does the gym, and then naps from 3 til 6. He does sometimes stay up until 1 or 2. I've told him to try and see a sleep therapist to get a better routine but he doesn't think it will help. He used to have insomnia pretty bad, but that doesn't seem to be an issue as much anymore. The issue with the sleep apnea is that he never gets quality REM sleep, so he might be in bed for 11 hours, but never actually gets decent sleep. So, my question here is: how normal is this for a man of his age and health condition? But, more importantly, what things should he do to advocate for his health and attempt to get a better quality of life? If he could feel rested for even 2 or 3 hours when he first wakes up, I think that would make him the happiest man alive. Could that be possible? Thank you for your help!
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Avatar universal
Given the history, your best advice will come from a medical professional who examines him and knows his complete med history.  No substitute for that.  Consider seeing an MD who specializes in sleep, look for AASM board certification.
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