Every so often i am woken up in the middle of the night with severe numbness and tingling in my hands. the pain ranges from uncomfortable to making me cry. could this be more than just carpel tunnel? what testing would be best to determine cause?

Carpal tunnel: Especially while sleeping, it is not unusual for your hands to flex at the wrist and remain in that position, pinching on the median nerve that goes to your hand. The pain and numbness is very uncomfortable and usually improves if you straighten your wrist and give it time to normalize. I usually try wrist splints at night to prevent this from happening. If it still happens,you need a hand surgeon

Some advice: Most likely, you do indeed have bilateral carpal tunnel syndrome, which is most often due to repetitive activities with your wrists and hands. Helps to confirm via an EMG-NCV test. Nocturnal hand/ wrist splints might relieve symptoms.

Possibly : More information needed as this could also be cubital tunnel syndrome where the ulnar nerve is compressed at the elbow. You may also have both. A NCS, nerve conduction study performed by a neurologist would confirm the diagnosis.

See a hand surgeon: Nighttime symptoms largely from prolonged wrist or elbow positioning can aggravate or exacerbate carpal or cubital tunnel syndrome. The diagnosis depends on where you are feeling the numbness. Carpal tunnel syndrome is the more common & nighttime bracing of the wrists can help. An emg/ncv study can determine which of the two you have and how bad it is. See a well-trained hand surgeon.