Brief Answer:
List of the possible causes for your tiredness ma'am, require some investigations too

Detailed Answer:
Hello ma'am and welcome to HCM.

Thank you for writing to us.

I have gone through your query with diligence and would like you to know that I am here to help. Taking into consideration your medical history, age and sex, there are a few causes that could be leading to your lethargy or tiredness:

From your history:

+Restless leg syndrome: Can result in poor quality of sleep which can also result in day time tiredness and lethargy

+Sleep apnea: Due to difficult in falling asleep or staying asleep, most patients with sleep apnea have poor quality of sleep which can also result in tiredness. I recommend you speak to your prescribing doctor to help better use of your CPAP machine

+Pramipexole use: Tiredness is also a common side effect of this medication, among a long list of other side effects

Other possible causes which should also be ruled out:

+Anemia: Is on top of the list, and I would recommend a blood test to rule out/confirm the same

+Menopause related: Can result in lethargy as a common symptom

+Nutritional deficiencies: Another common cause (e.g. iron, vitamin D, vitamin B12, vitamin B9, etc.)

+Dehydration: You need to be taking at least 2-3 liters of fluids per day

+Conditions which are causing bleeding: These can also result in anaemia and thus the tiredness

+Chronic conditions: Diabetes, thyroid abnormalities, arthritis, kidney diseases, etc.

I would thus recommend an elaborate evaluation (primarily blood tests) to rule out other causes and accordingly direct treatment for the 3 top most suspected causes on the list ma'am. Please also speak to your treating doctor to help with either avoiding this side effect or with better management. I hope you find my response helpful. Please do not hesitate to write to me, I am always here to help.

Best wishes.

---