Well, I can't imagine there being a huge enough difference from the top of the substrate to 1-2 inches above it to be concerned about. I just checked mine and I had to go about 3-4 inches before it even changed one degree - no biggie. I won't say ambient is not important - I'll just say I get the impression it's not and I don't worry about it. I mean, yeah caresheets might mention ambient, but whenever I've talked with anyone in person or on forums they never give or mention ambient temps - just surface temps. So I don't worry about it.
What are you using to measure these temps (analog, stick on liquid therm, digital, temp gun, etc)?
In the summer I only used a 100 watt bulb and in the winter I went up to a 150 watt bulb (both infrared heat bulbs by Exo-Terra). However, I could probably go with an even lower wattage. These wattages kept the surface temps on the cool side at 80-85 degrees (depending on the spot you measure at). My tank is 19" tall. But, the branch that he likes to hang out on that is directly under the red light can get up to 100 degrees - but he seems to like it.
It's kind of weird because the surface temps on the warm side are 90-95 (again depending on the spot you measure) but the ambient temps are more 80-85, while the cool side surface temps are 80-85 and the cool side ambient is 90-100. It's like I have a criss-cross temperature gradient go on. I guess it's also possible that the high wattage bulb I have is also helping to keep the ambient temps on the warm side up as well - even though the main purpose of it is for the cool side.
I do believe my BP is a healthy one: vet check was great, eats very well (didn't go off feed as others did this winter), he makes use of all his hides and deco (shows he's thermoregulating and is able to find the temps he wants), no regurg or other illnesses and perfect sheds. He's also not nippy or nervous (so I like to believe that means he's not stressed and feels secure and comfortable both in his home and with me).
If you have a 20 gallon high (16" height) you might try your 75 watt out first and see how it does before buying another one. If it is too hot or you have a 20 gallon long (12" height) than I'd go for a smaller wattage.
Again, my think with the ambient temps is that if you don't even have any deco, etc for your BP to climb on to get up that high - I wouldn't stress those temps too much.
You also have to read your BP. He/she should have the temp gradient and you should see them thermoregulating. If they spend nearly all their time in the same spot/side, then that may be an indicator that the temps on the other side are too cool or hot - or there arent' any good hides on the other side.

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