Do you have a factory RS3000 alarm system?
I had similar symptoms.
I replaced the battery, as my Ultragauge would register dropping voltage as I sat at a stop light, and battery tested as bad.
Problems persisted.
Replaced the alternator, as I assumed that the alternator was not keeping up and I had no idea if the alternator was original or not with 250K on the truck. (turns out it had a reman on it). New one did better, but not enough. Over time, it improved (why, I don't know....) but it is an O'Reilly special.
Replaced the battery again. Helped even more.
Had a no-start on the truck due to what appeared to be dead battery. Tried to jump and starter dead.
Replaced the starter.
Problems solved.
I believe I was having a constant drain from bad starter contacts, but I never measured it. Some of this stuff I replaced because I figured it was time so it was kind of PM as well as throw money at it to fix. I don;t normally do things that way, but I needed to refresh the parts anyway.
I also discovered later that the alarm system was causing random drains on the battery. It would go dead overnight sometimes, other times not. After the alarm decided to wig out, I ripped it out and have not had ANY electrical issues since.