Background: Insomnia is common in patients undergoing maintenance hemodialysis (MHD). Long-term use of sedative-hypnotic agents is often correlated with increasing adverse effects. Auricular acupressure therapy (AAT) applied to specific auricular acupoints for managing insomnia has achieved favorable outcomes in a hemodialysis unit. This pilot study was performed to demonstrate the potential of AAT for insomnia in MHD patients and to prepare for a future randomized controlled trial. Methods: Eligible patients were enrolled into this descriptive pilot study and received AAT designed to manage insomnia for 4 weeks. Questionnaires that used the Pittsburgh sleep quality index (PSQI) were completed at baseline, after a 4-week intervention, and 1 month after completion of treatment. Sleep quality and other clinical characteristics, including sleeping pills taken, were statistically compared between different time points. Results: A total of 22 patients were selected as eligible participants and completed the treatment and questionnaires. The mean global PSQI score was significantly decreased after AAT intervention (p < 0.05). Participants reported improved sleep quality (p < 0.01), shorter sleep latency (p < 0.05), less sleep disturbance (p < 0.01), and less daytime dysfunction (p = 0.01). They also exhibited less dependency on sleep medications, indicated by the reduction in weekly estazolam consumption from 6.98 +/- 4.44 pills to 4.23 +/- 2.66 pills (p < 0.01). However, these improvements were not preserved 1 month after treatment. Conclusion: In this single-center pilot study, complementary AAT for MHD patients with severe insomnia was feasible and well tolerated and showed encouraging results for sleep quality.