Recall that in the Nadal-Tsitsipas AO SF Stef didn’t even reach break point until the last game, then he didn’t take it. In their Toronto 2018 match he broke once (when Nadal was serving for the match). He hasn’t reached BP in their last match and possibly won’t here.
If you can’t break Nadal, you’re almost certainly not going to beat him. Gotta be able to take advantage of his serve, improved though it is. This 5-1 H2H isn’t surprising, and it is looking increasingly like Tsitsipas’s win in Madrid was an anomaly.
The return is one of the reasons why Federer suffered against Nadal for so long. Just couldn’t do enough damage on the backhand return. It’s also no coincidence that the player with the most wins against Nadal — Djokovic — has the best return game ever.