Does norm crp, esr rule out autoimmune diseases or malignancies? 1 yr worsening tired/sleepiness; normal polysom/cbc/cmp/crp/esr/tsh. next eval step?

No: C-reactive protein and sed rate are neither sensitive nor specific. Rule out pituitary adenoma, bad home heater (carbon monoxide), Addison's, early lupus (get ANA), early MS (any findings), complications of those meds you're taking (that's some serious Rx's), fibromyalgia, and the fatigue that a difficult living situation can cause. The lab workup you describe is a good start.