The pain and PT you describe sounds like par for the course with TOS. The fact that you also have carpal tunnel is a complicating factor.

You must get the sleeping under control. I was once caught in the vicious cycle in which sleeping was making me worse each day. I started seeing a neurologist who's specialties include pain management and sleep disorders (I don't have sleep disorder...just pain). I suggest seeing a pain management doc and finding the right drug regimen. With this bad pain, it must be managed or else it just multiplies.

Now I start my mornings out feeling pretty good (especially after a long hot shower). Things still go downhill as the day progresses. But, it is hell when you wake up with excruciating pain and know it is only going to get worse. You must avoid this place.