Background: Sleep disturbances and fatigue frequently occur in patients undergoing hemodialysis. This study investigated whether a combination of sleep hygiene education and lavender aromatherapy improved sleep quality and fatigue. Methods: A quasi-experimental, non-equivalent control-group pretest– posttest design, enrolling 84 patients consecutively and allocating them basedon pre-existing hemodialysis schedules (42 intervention; 42 control). The intervention group received two sessions of sleep hygiene education and nightly lavender aromatherapy via reed diffuser for four weeks, while the control group received usual care. We measured sleep quality and fatigue using the Pittsburgh Sleep Quality Index (PSQI) and the FACIT-Fatigue Scale. Group-by-time effects were analyzed using generalized estimating equations. In the intervention group, median PSQI scores improved from 19.00 (IQR 17.25–20.00) to 2.00 (IQR 1.00–3.00), while the control group changed from 19.00 (IQR 17.00–20.00) to 18.50 (IQR 17.00–20.00). Result: Median FACIT-Fatigue scores increased from 25.00 (IQR 20.00– 27.00) to 48.00 (IQR 44.00–50.00) in the intervention group and from 22.00 (IQR 20.00–24.00) to 23.00 (IQR 21.00–25.00) in the control group. Significant group-by-time interactions were observed for PSQI (β = −16.44, 95% CI −17.22 to −15.65; p < 0.001) and FACIT-Fatigue (β = 22.26, 95% CI 20.61–23.91; p < 0.001). Conclusion: The combination of sleep hygiene education and lavender aromatherapy led to greater improvements in sleep quality and fatigue than usual care. However, interpret these findings with caution because the groups were not randomized.