This is a parallel group randomized controlled trial looking at insomnia in the dialysis population. 126 hemodialysis patients will be enrolled in community-based dialysis facilities in Seattle and New Mexico and randomized to 6 week treatment to telehealth cognitive based therapy, trazodone, or medication placebo. Response to treatment will be assessed after 6 weeks of treatment, and persistence of treatment effect will be ascertained at 25 weeks.